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Understanding Surgeon Engagement with Palliative Care Practices for Seriously Ill Patients: A Qualitative Study
Claire R Morton1,2,3, Amanda J Reich1, Weijia Sun1
1Center for Surgery and Public Health, Brigham and Women's Hospital.
Annals of Surgery
|May 22, 2026
Summary
Surgical clinicians provide palliative care (PC) aligned with PC goals for older adults, even when they believe PC conflicts with surgery. Reframing surgeon identity and highlighting PC-surgery overlap can improve care integration.
Area of Science:
- Geriatric Medicine
- Surgical Oncology
- Palliative Care
Background:
- Palliative care (PC) is underutilized in major elective surgery for seriously ill older adults, despite guidelines.
- A gap exists between professional recommendations and clinical practice regarding PC in this population.
Purpose of the Study:
- To investigate surgical clinicians' understanding and application of palliative care (PC) in major elective surgery for older adults.
- To identify barriers and opportunities for integrating PC into surgical care pathways.
Main Methods:
- Observational study of clinic encounters and interviews with surgeons and clinicians across multiple surgical disciplines.
- Deductive analysis of 207 patient encounters and 15 clinician interviews within a regional health system.
Main Results:
- Clinicians across surgical fields delivered care consistent with PC principles, contrary to some surgeons' beliefs about conflict.
- Surgeons often redirected discussions from psychosocial distress to biomedical issues, even when patients expressed spiritual or emotional concerns.
- Opportunities for improved integration include reframing the surgeon's role beyond a "fixer" to include non-surgical approaches and emphasizing shared goals between surgery and PC.
Conclusions:
- Aligning surgical practice with palliative care offers significant opportunities to better meet the comprehensive needs of seriously ill older surgical patients.
- Integrating PC requires addressing the perceived conflict between surgical intervention and supportive care, and enhancing communication around psychosocial issues.
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