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Palliative Care in Surgery: Updated Research Priorities from the Surgical Palliative Care Research Expert Consensus
Bonnie O Wong1,2,3, Daniel I Hoffman1,2,3, Kenneth Williams1,4
1Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA.
Background:
Surgical palliative care (SPC) research has advanced since the 2017 research agenda, but persistent gaps in patient selection, intervention delivery, and outcome measurement limit implementation across evolving surgical care settings.
Study Design:
In November 2025, a national consensus conference convened 28 SPC experts and researchers. Through iterative discussion and consensus-building during the meeting and subsequent months, participants updated research priorities across the surgical continuum and health system context. Full methodology and participant attributes were described in Supplemental Materials https://links.lww.com/JACS/A821.
Results:
The updated agenda identified 11 research gaps across 3 priority areas: patient selection; interventions, care processes, and competencies; and outcome measurement. Priorities were mapped at 2 levels: surgical episodes, encompassing patient-, family-, and provider-level factors, and health systems, encompassing organizational and structural factors affecting SPC delivery. The agenda prioritizes identifying which patients benefit from SPC and when; broadening SPC beyond traditional populations; defining primary SPC competencies and the role of specialty consultation; improving communication of surgical intent, trade-offs, and preference-sensitive decisions; integrating and sustaining SPC across heterogeneous systems and care transitions; transforming clinical cultures; and developing patient-centered, context-specific surgical and systems-level outcomes. Emerging electronic health record, natural language processing, and large language model approaches may support scalable patient identification, intervention delivery, and outcome measurement, while requiring attention to bias and task-dependent performance.
Conclusions:
SPC research should move beyond narrow proof-of-concept settings toward pragmatic, scalable approaches that define who should receive SPC, what should be delivered, and how success should be measured across diverse surgical environments.