Patient Perceptions of Palliative Care in Surgery: A Qualitative Study.

BACKGROUND

Despite professional guidelines encouraging integration, palliative care (PC) remains underutilized among surgical patients.

OBJECTIVES

We sought to characterize contextual factors influencing PC integration in surgical practice from the patient perspective.

METHODS

We used a combination of ethnographic observations and semistructured interviews with seriously ill older adults to explore perceptions of and behaviors related to PC among patients undergoing surgery.

RESULTS

Across 207 observations and 19 interviews, we identified that patients were either unaware of PC or equated it with end-of-life care, believing that pursuing PC would mean forgoing surgery or efforts at recovery. Patients were nevertheless observed elevating concerns related to PC domains, including social or psychological burdens, during visits with surgeons. When presented with a comprehensive definition of PC, some patients were receptive to increased integration with surgery, whereas others preferred that their surgeons contribute only technical expertise.

CONCLUSIONS

Our results offer new perspectives on established findings, including that patients equate PC with hospice and end-of-life treatments. Although patients in our study endorsed these same attitudes, they also exhibited interest in discussing broad domains of PC with their surgeons, highlighting further opportunities for integration.