Goals of Care with Palliative Surgery

Abstract

Almost all surgical procedures have a palliative component to them in that they aim to relieve symptoms of some disease process or injury. Some patients who have life-threatening illnesses or are at the end of their lives may still benefit from surgical procedures, even if the goal of the therapy is not curative. In this chapter, we explore the reasoning prerequisite to offering palliative surgical procedures. The surgeon, the patient, and/or the patient’s surrogate may be confused about the goals of care for palliative surgical therapy. The patient’s goals of care may change as the disease progresses and curative management may transition into palliative management. It is important to explore goals of care at pivotal decision points with the patient, family members, and friends in a multidisciplinary care setting that ideally includes the patient’s primary care physician, relevant specialists, critical care team, and surgeon in order to fully explore all palliative options and set realistic goals and expectations in line with the patient’s wishes and values prior to offering palliative surgical therapy.