Primary palliative care for surgeons: a narrative review and synthesis of core competencies

The practice of palliative medicine has grown substantially over the last two decades and the data demonstrates that seriously ill and injured surgical patients as well as their loved one's benefit from the integration of palliative care into standard surgical management. This narrative review highlights the patient and family benefit of primary surgical palliative care (PSPC) for seriously ill or injured surgical patients and the need for primary palliative care (PPC) skill acquisition by surgeons. The review encourages surgeons to identify all aspects of suffering as a critical component of the care needs of surgical patients and families and to consider integrating mitigation strategies during surgical care. Identification of suffering has not been traditionally taught in surgical training or reinforced in surgical practice, therefore current surgical educational opportunities should incorporate such instruction to assist surgeons in training and in practice to acknowledge and treat suffering to improve and expand the quality and value of surgical care offered to seriously ill or injured surgical patients. Additionally, a patient-centered approach to surgical care necessitates engaging advanced communication skills to successfully ascertain a patient's and/or their surrogate decision maker's, substituted goals and values in the provision of surgical care to ensure that all the care delivered is aligned with each patient's preferences. A preliminary synthesis of core competencies to achieve these SPC objectives is presented.