A defining feature of the ACS is our ability to contribute meaningfully to the careers of all surgeons and expand perspectives across surgical disciplines. One example that may not immediately be top of mind is our work in surgical palliative care.
To some, the phrase “surgical palliative care” may sound contradictory. Our procedures can be invasive, while palliative care sometimes means minimizing or avoiding procedures. At its core, however, palliation focuses on reducing discomfort, improving quality of life, and aligning the care a patient receives with that patient’s stated goals.
While palliative care may be part of end-of-life care, the concept applies to any patient who may benefit from surgery meant to improve quality of life without curing disease. In that sense, a palliative care perspective could be part of many of our practices.
The ACS has contributed to groundbreaking initiatives in surgical palliative care for 30 years, dating back to the beginning of these care considerations.
The College began playing a role in the advancement of palliative surgical care when Olga Jonasson, MD, FACS (1934–2006), a legendary transplant surgeon, became the Director of what is now the ACS Division of Education in 1993. In that role, she spearheaded early efforts to inform ACS members about palliative care.
Building on her intended commitment, we have continued activities in palliative surgery, including efforts to unite surgeons to develop principles of the field. In 1998, the ACS Committee on Ethics released the Statement of Principles Guiding Care at the End of Life, followed in 2005 by the revised Statement of Principles of Palliative Care. In 2009, a team led by the prominent palliative surgeon Geoffrey Parker Dunn, MD, FACS, helped the ACS create a guideline on palliative surgical care for resident physicians. In 2017, the ACS Trauma Quality Improvement Program (TQIP) released the ACS TQIP Palliative Care Best Practices Guidelines, which aim to bridge gaps in palliative surgical care for trauma patients.
Over time, our work on palliative care has also included numerous other activities such as launching committees and workgroups, adding the topic to multiple editions of the ACS Surgical Education and Self-Assessment Program (SESAP®), and running a 4-year-long series of articles on palliation in the Journal of the American College of Surgeons.
We have also maintained an ongoing focus on research. The ACS recently hosted the 8th annual Symposium for Research in Surgical Palliative Care. During that virtual program in May, surgeon-scientists presented studies on palliative care, illuminating cancer care, common misconceptions, and surgeon-patient communication. In addition, we have featured panel sessions on surgical palliative care at Clinical Congress. This year’s schedule includes multiple sessions on the topic (see sidebar).
Our involvement also extends to updating our own Quality Programs. For example, purpose-built data collection tools are generally required to appropriately capture the intent for a surgery to be palliative. To that end, the ACS National Cancer Data Base, which captures data from approximately 1.4 million US cancer patients per year, now includes data fields for surgical procedures intended to be neither diagnostic nor curative.
In addition, our Division of Research and Optimal Patient Care is integrating surgical palliative care into the Geriatric Surgery Verification (GSV) Program. The ACS launched the GSV Program in 2019 to improve the surgical care of all patients 75 years and older. From the start, its implementation has required the involvement of each hospital’s palliative care team to help ensure our process reflects the multidisciplinary nature and specific staffing required to deliver high-surgical care. With generous funding we received from The John A. Hartford Foundation, we are now working to better incorporate palliative care into the GSV standards. Our quality team also successfully worked with the Centers for Medicare & Medicaid Services to create a new Age Friendly Measure predicated on GSV program to improve the care and outcomes of older adult patients. Hospitals will be required to report their compliance with this new measure beginning in January 2025; compliance information will be publicly available in 2026.
While hospice and palliative medicine is a specialty unto itself, its insights are applicable to surgeons in many disciplines. As always, we use our powerful history and infrastructure to unite all surgeons for meaningful improvements in how we practice. If you are interested in learning about palliative care, please engage with our resources on this important topic at this year’s Clinical Congress and beyond.
Register for Clinical Congress
Join us in San Francisco from Saturday, October 19, to Tuesday, October 22, for this year’s meeting of the House of Surgery. We look forward to more than 100 Panel Sessions, eight Named Lectures, and many more meetings, sessions, and special events. Learn more and register at facs.org/clincon2024.
