The surgeon's role in delivering palliative care practices: a narrative review

Palliative care aims to improve quality of life and reduce suffering among patients facing serious illnesses and their families. Patients with surgical conditions have various palliative care needs, although the incorporation of palliative care principles in perioperative care may be suboptimal. The aims of this narrative review are to define and delineate the surgeon's role in integrating palliative care in surgical practice, through highlighting strategies and opportunities for surgeons to engage with patients, families, and interdisciplinary palliative care providers.

We searched PubMed and EMBASE databases for English-language publications dated between January 2010 to May 2024, according to the search terms: "palliative care", "surgery", and "surgeon". Inclusion criteria were: (I) studies involving adult patients (given differing considerations in pediatric populations); (II) original quantitative or qualitative research (i.e., those with primary data), including case reports and series; and (III) a primary focus on palliative care in the context of surgical conditions. A total of 713 manuscripts were initially identified to be potentially relevant and a total of 43 articles were included for this review. In addition, we describe an illustrative case involving a patient with a surgical condition facing critical illness to highlight opportunities for surgeons to engage in serious illness communication and palliative care.

We emphasize the surgeon's roles in both perioperative communication and shared decision-making with patients and families regarding surgical interventions, along with potential strategies for improved communication and enhanced primary palliative care skills. In addition, we describe valuable opportunities for surgeons to collaborate with interdisciplinary palliative care teams in the care of patients with surgical conditions.

Opportunities for surgeons to utilize palliative care approaches and engage with palliative care specialists in surgical and perioperative care exist, which may improve the patient and family experience.