Palliative Care Throughout the Entire Perioperative Pathway in Cardiovascular Surgery

Area of Science:

• Cardiology
• Palliative Care
• Surgical Oncology

Background:

• Cardiovascular surgery improves survival but faces challenges with older, multimorbid patients with advanced disease.
• These complex patients experience significant physical symptoms, psychological distress, and difficult end-of-life decisions.
• Current care models may not adequately address the comprehensive needs of these patients throughout their surgical journey.

Purpose of the Study:

• To advocate for integrating palliative care throughout the cardiovascular surgery pathway.
• To demonstrate how palliative care can address complex patient needs beyond end-of-life care.
• To highlight the benefits of structured decision-making, symptom management, and interdisciplinary support.

Main Methods:

• The article proposes a framework for integrating palliative care across the cardiovascular surgery continuum.
• It emphasizes structured shared decision-making, goals-of-care discussions, and advance care planning preoperatively.
• Postoperative strategies include routine symptom assessment, psychological support, and interdisciplinary team involvement.

Main Results:

• Preoperative palliative care aligns surgical plans with patient values and prepares families for complications.
• Postoperative palliative care alleviates suffering by managing physical, psychological, social, and spiritual needs.
• Interdisciplinary support and clear communication aid decision-making during serious complications, reducing distress.

Conclusions:

• Palliative care offers a vital framework to manage complex needs in cardiovascular surgery patients.
• Primary palliative care by surgical teams is feasible for most needs, with specialty palliative care for complex cases.
• Further research, education, and guidelines are essential to establish palliative care as a routine component of cardiovascular surgical care.