TABLE 1.

Current Knowledge Gaps in Palliative Care in Surgery

Research Focus Area	Current Knowledge Limitations
Defining outcomes that matter to patients
Defining outcomes that patients value	The scope of most surgical outcomes research is limited to short-term survival. Few studies have examined other outcomes (function, quality of life, time in ICU, etc) that patients value after surgery or defined the benefits and tradeoffs of surgery from the patient’s perspective. Existing measures for palliative care outcomes have not been validated for surgical patients and are not readily translated to surgical care.
Measures to evaluate high-quality palliative care in surgery	Processes of care that are common in palliative care, including communication about goals of care and documentation of a surrogate decision maker, have not been used as quality indicators in surgical care. There is a lack of appropriate quality metrics that align with the goals of palliative surgery, such as quality of life, functional status, and relief from symptoms. There is no uniform system for classifying palliative versus curative intent of surgery.
Communication and decision making
Aligning surgical treatments with patient-oriented outcomes	Prior studies have described communication strategies for surgical decisions, but little is known about whether they lead to treatment decisions that are concordant with patients’ preferences.
Preoperative advance care planning	Evidence for preoperative advance care planning conversations is limited to small, single-institution studies, and impact on patient- oriented outcomes is lacking.
Decision making after postoperative complications or critical illness	Studies have not examined communication strategies with patients and surrogate decision makers about postoperative care after complications or critical illness.
Delivery of palliative care to surgical patients
Integrating palliative care principles into routine surgical practice	Few studies have examined the feasibility or efficacy of integrating primary palliative care into surgical practice and culture, including strategies for process change and workforce education.
Developing scalable models of primary palliative care delivery for surgical patients	No studies have evaluated models for surgical palliative care that can be scaled to populations in the perioperative setting.
Identifying patients who would benefit from palliative care specialist consultation	Studies using various criteria for screening palliative needs in surgical patient populations have reported mixed results from interventions to increase palliative care consultation.