Palliative care in surgery: Where are we at?

Area of Science:

• Surgical Oncology
• Palliative Medicine
• Health Services Research

Background:

• Palliative care integration into surgical practice for adults with serious illness is suboptimal.
• Most surgeons do not routinely incorporate palliative care principles into their surgical care.

Purpose of the Study:

• To investigate barriers hindering the integration of palliative care within surgical settings.
• Utilized a socio-ecological framework to comprehensively analyze these barriers.

Main Methods:

• Conducted a qualitative study involving semi-structured, video-based interviews with surgeons.
• Data collected from a tertiary academic center in Singapore (April-July 2023).
• Employed reflexive thematic analysis informed by the socio-ecological model (SEM).

Main Results:

• Identified individual-level barriers: insufficient palliative care training and professional identity misalignment.
• Interpersonal and community barriers include poor intra- and inter-team collaboration.
• Organizational and policy barriers involve subspecialization, lack of incentives, and inadequate support.

Conclusions:

• Barriers to surgical palliative care integration exist across multiple socio-ecological levels.
• Findings suggest the need for targeted interventions to enhance palliative care delivery in surgical contexts.