In Surgical Practice

Palliative care throughout surgical care

Surgical patients face some of medicine’s most consequential decisions, often quickly, often under uncertainty, and often with families who had no warning. Palliative care shows up across the whole surgical course.

A surgeon in a blue scrub cap and mask in an operating room

Surgery carries its own long palliative tradition: operations performed not to cure but to relieve, such as bypassing an obstruction, draining an infection, stabilizing a fracture, or restoring the ability to eat or breathe. A palliative operation and palliative care are not the same thing, though. One is a procedure. The other is a way of practicing that attends to suffering, prognosis, and the patient’s goals before, during, and after any procedure, including the decision not to operate.

Good palliative care doesn’t always point away from surgery. Sometimes, after an honest conversation about what an operation can and can’t offer, it supports proceeding with a high-risk operation, because that is the choice most consistent with what the patient hopes to protect. Comfort isn’t what medicine offers once treatment has failed, either. It is a responsibility throughout treatment, including the most aggressive surgical care, where technical skill and human presence both belong to doing the work well.

Before the operation

High-risk surgery

Helping older and seriously ill patients weigh what an operation can realistically offer, including the best case, the worst case, and the most likely recovery, against what they hope to protect.

The first hours

Trauma

Sudden, catastrophic injury leaves no time to prepare. Early and honest communication with families, careful prognosis in the first hours and days, and attention to what the patient would have wanted.

The ICU

Surgical critical care

Time-limited trials of intensive treatment, regular family meetings, and recognizing when treatments are no longer moving a patient toward goals they would choose.

Admission onward

Burns

Prognostic uncertainty, intense pain and symptom burden, and long recoveries make palliative skills essential from the first day, for survivors as much as for patients who will not survive.

Throughout treatment

Surgical oncology

Palliative operations for obstruction, bleeding, or pain; decisions about when another operation serves the patient’s goals; and symptom management at every stage.

Often at night

Emergency general surgery

Older adults living with serious illness who arrive with an acute surgical emergency, often without any prior conversation about their goals, when the decision to operate carries the highest stakes.

After the operation

Postoperative complications

When recovery doesn’t go as planned: revisiting goals as the picture changes, treating the symptoms that come with setbacks, and supporting patients and families through decisions no one expected to face.

Beyond the forecast

Unexpected recoveries

Some patients recover far beyond what anyone predicted. Palliative care makes room for that uncertainty, holding hope and planning together, and adjusting the plan as a patient improves.

The skills underneath

CommunicationSharing serious news, eliciting goals and values, leading family meetings.

Symptom managementPain, nausea, breathlessness, delirium, and distress, before and after surgery.

Prognostic uncertaintySaying honestly what we know and don’t know, without false precision or false hope.

Shared decision-makingPresenting surgery and its alternatives, including non-operative care, as real options.

Goal-concordant treatmentMaking sure what we do matches what the patient would want.

None of these requires a fellowship. All of them can be learned, which is the point of the pathways in Learning & Teaching.