Surgeon Perspectives on Palliative Care: Are We the Barrier to Better Care?

AbstractSurgeons face numerous perioperative challenges when caring for patients with life-threatening or chronic diseases. Although palliative care teams are uniquely poised to aid in the supportive approach to such holistic needs, they are underutilized by surgical services. Palliative care has been associated with an average reduction of $3,237 per admission, as well as reduction in emergency department visits, hospital admissions, and hospital length of stay. For patients within the intensive care setting, palliative interventions have shown a 26 percent relative risk reduction in intensive care unit length of stay and overall alignment of patients' and families' goals of care. However, there is a paucity of data surrounding outcomes associated with palliative care in surgery. It remains pervasive in surgical culture that operative intervention and palliation are mutually exclusive and occur sequentially, rather than concurrently. The majority (76.1%) of surgeons have no formal education in palliative care and feel burdened with the unrealistic expectations for patient outcomes after surgical intervention (61.8%). These cultural and knowledge barriers have significant impact on surgical palliative care referrals and team-based care. Preoperative palliative care consultations in surgical patients occur less than 1 percent of the time. Preoperative palliative care may serve to help explore, clarify, and document quality-of-life values and preferences, in hopes of better promoting goal-concordant care. We recommend implementing frailty-score-based risk assessments to refer surgical patients to palliative care consultation preoperatively. Normalizing referral to palliative care can help surgeons embrace its potential benefit in patient care and improve utilization.