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Using a Palliative Care Framework for Seriously Ill Surgical Patients The Example of Malignant Bowel Obstruction

Elizabeth J. Lilley, MD, MPH1,2; Christy E. Cauley, MD, MPH3,4; Zara Cooper, MD, MSc2,5
[+] Author Affiliations
1Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
2Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, Massachusetts
3Department of Surgery, Massachusetts General Hospital, Boston
4Ariadne Labs, Boston, Massachusetts
5Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
JAMA Surg. 2016;151(8):695-696. doi:10.1001/jamasurg.2016.0057.
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This Viewpoint discusses how surgeons can integrate principles of palliative care to support surgical care for patients with life-threatening illness, using malignant bowel obstruction as an example.

In the recent report Dying in America: Addressing Key End of Life Issues,1 the Institute of Medicine declared improving access to palliative care for seriously ill patients a national priority to address the crisis of low-value health care for patients near the end of life. Patients report comfort, symptom control, and dignity as central to achieving a “good death,” yet increasing numbers experience pain, unwanted health care transitions, and intensive care near the end of life. Surgeons play a critical role as providers of end-of-life care. Among Medicare decedents, almost one-third have surgery in the year before death, many in the last week of life,2 and up to 25% of patients diagnosed as having stage IV cancer undergo a surgical procedure. Palliative care, an approach to care focused on improving quality of life for patients with life-threatening illness and their families, is associated with improved symptom management, improved communication, and fewer care transitions for seriously ill patients. Although surgeons routinely care for seriously ill patients, the role of palliative care in surgery remains poorly defined.3 Herein, we use malignant bowel obstruction (MBO) as an example of how surgeons can integrate principles of palliative care to support surgical care for patients with life-threatening illness.

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