Palliative care in acute care surgery: research challenges and opportunities

Palliative care includes effective communication, relief of suffering and symptom management with an underlying goal of improving the quality of life for patients with serious illness and their families. Best practice palliative care is delivered in parallel with life-sustaining or life-prolonging care. Palliative care affirms life and regards death as a normal process, intends neither to hasten death nor to postpone death and includes but is not limited to end-of-life care. Palliative care encompasses both primary palliative care (which can and should be incorporated into the practice of acute care surgery) and specialty palliative care (consultation with a fellowship-trained palliative care provider). Acute care surgeons routinely care for individuals who may benefit from palliative care. Patients exposed to traumatic injury, emergency surgical conditions, major burns and/or critical surgical illness are more likely to be experiencing a serious illness than other hospitalized patients. Palliative care research is urgently needed in acute care surgery. At present, minimal high-quality research is available to guide selection of palliative care interventions. This narrative review summarizes the current state of research challenges and opportunities to address palliative care in acute care surgery. Palliative care research in acute care surgery can rely on either primary data collection or secondary and administrative data. Each approach has its advantages and limitations, which we will review in this article.