Palliative Surgical Discipline

Palliative Care and Surgical Disciplines:

Palliation and surgery have a historical association. The word ‘palliative’ was first used by a surgeon, a urologic oncologist, who established the world’s first acute care hospital in-patient palliative care service at the Royal Victoria Hospital in Montreal in 1974 [2]. Surgeons, irrespective of their specialty, encounter a wide spectrum of death and dying in their daily practice – this may be a patient with severe trauma, burn or advanced stage cancer or a critically ill patient in a surgical intensive care unit (SICU); death may occur unexpectedly due to internal catastrophes such as bleedings, ruptures or perforations; occur peri-operatively in a patient with multiple morbidity and chronic diseases;

Surgical palliative care is the treatment of suffering and the promotion of quality of life for patients who are seriously or terminally ill under surgical care and prolonged survival has been identified as potential outcome for palliative surgical procedures that were previously recommended for symptom control only [17]. Surgical patients, who receive palliative care, have been reported to live significantly longer than the medical patients [40, 41]. Unfortunately referrals from surgical services for palliative care consultations are much less and fewer surgical patients receive palliative care in the year prior to death when compared with their medical counterparts [42,

This sub-optimal focus on the surgical palliation may affect surgeons’ decision-making ability to offer consensus treatment option for palliative intervention for common symptom management or in advanced conditions to suit individual patient’s needs.

In addition to the deficiencies in the clinical palliative care skills mentioned earlier, studies have identified sub-optimal softer skills among surgery residents such as selection of words in delivering bad news, dealing with ethical issues related to disease disclosure to the patient or the family, responding to their subsequent emotional reactions and recognizing the need for referral to psychiatrist [45, 49, 50]. Formal programs to teach these competencies are lacking. Table 1 gives an overview of different components of a proposed palliative care curriculum for surgeons.

Palliative Care Service and Education in