Palliative care in surgery: Where are we at?

Background: Palliative care should be delivered alongside surgical care for adults with serious illness. Yet, most do not routinely integrate palliative principles in their surgical practices. Objectives: This study aims to examine barriers to integration of palliative care in surgery using a socio-ecological framework. Design: A qualitative study using semi-structured, video-based interviews was conducted. Methods: Qualitative interviews were conducted between April and July 2023 in a tertiary academic center in Singapore. Surgeons were purposively sampled across various surgical subspecialty teams. The interview guide was informed by the socio-ecological model (SEM), exploring individual, interpersonal, community, organizational, and policy level barriers to surgical palliative care, that is, the integration of palliative care principles in surgical care. Reflexive thematic analysis was used to analyze the data. Results: Fourteen surgeons (50% male, with an average of 12 years of practice) participated in this study. Three themes were constructed, based on the SEM framework. At the individual level, inadequate palliative care training and a misalignment between the surgeon’s professional identity and their understanding of palliative care impede the delivery of surgical palliative care. At the interpersonal and community level, poor intra- and inter-teamwork act as barriers. At the organizational and policy level, subspecialization, lack of incentives, and organizational support further inhibit the practice of surgical palliative care. Conclusion: Barriers to the integration of palliative care in surgery exist at multiple levels of the SEM. Our findings highlight opportunities for targeted interventions to improve the delivery of palliative care for adults with serious illness in surgery.