Acute care, acute conversations: palliative care needs in acute care surgery

Maiga et al¹ present an insightful review addressing the challenges at the intersection of palliative care and acute care surgery (PC/ACS). They emphasize that primary palliative care skills are essential for acute care surgeons,² yet research in this domain is hampered by limitations in existing large datasets (eg, Trauma Quality Improvement Program), which fail to capture critical palliative care interventions, discussion details, and patient-centric outcomes. This gap compels surgeons to adopt innovative data collection methods—such as natural language processing and mixed-method studies—to build larger, more nuanced datasets.

The review also underscores the value of incorporating standardized assessment tools, including the Decisional Regret Scale and the Needs at End-of-Life Screening Tool, in these new datasets. These instruments provide objective metrics that extend beyond traditional measures like mortality, length of stay, and the decision to operate. They quantify the emotional and cognitive burdens associated with high-stake decision-making and acknowledge that long-term survival may not align with patients’ goals.

A central theme is the urgent need to improve goal‐of‐care discussions in the acute surgical setting, a focus of our own work.³,⁵ Although progress has been made in trauma and surgical critical care, the challenges faced by the acute care surgeon are unique and understudied.²,⁵ The authors advocate for standardized, surgery-specific communication tools. Applying established and rigorous frameworks, such as the best-case/worst-case tool, may prove more fruitful than developing new ACS-specific tools from scratch.

Overall, Maiga et al call for a comprehensive research strategy that integrates innovative data collection with robust, patient-centric clinical protocols. Addressing these gaps is pivotal for advancing a comprehensive and compassionate model of palliative care in the ACS setting.