Research Spotlight: Characterizing Patient Perceptions of Palliative Care in Surgical Settings

Claire Morton, MD, and Zara Cooper, MD, MSc, of the Center for Surgery and Public Health within the Department of Surgery at Mass General Brigham, are the lead and senior authors of a paper published in the Journal of Pain and Symptom Management, “Patient Perceptions of Palliative Care in Surgery: A Qualitative Study.”

Q: What challenges or unmet needs make this study important?

Palliative care models aim to improve the quality of life and symptom burden of patients facing serious illness at any stage. While established practice guidelines encourage the integration of palliative care into surgical practice, there’s a significant gap between these formal guidelines and actual utilization by surgical patients.

For example, previous studies have indicated that patients undergoing major elective surgeries were unlikely to receive palliative care services, despite recommendations. This study helps us better understand, in the words of patients themselves, why this may be the case.

Q: What central question(s) were you investigating?

We sought to understand the contextual factors that influence how palliative care is delivered by surgeons and perceived by patients. Specifically, we aimed to characterize how these factors shape the provision of palliative care to seriously ill older adults undergoing major elective surgery. This work was part of the Layered Examination of Adult Palliative Care in Surgery (LEAPS) study.

Q: What methods or approach did you use?

We observed surgeons and patients during routine interactions in clinics to gain a deeper understanding of the dynamics and content of surgical consultations and counseling. This ethnographic approach of studying individuals in real-life contexts allowed us to capture natural interactions and factors influencing patient care.

Following these observations, we conducted semi-structured qualitative interviews with patients to further explore their experiences and perceptions. In these interviews, we asked patients to describe what they believed palliative care entails, what their personal experiences with palliative care in surgical settings had been like, and how they felt palliative care and surgical care could be effectively integrated.

Q: What did you find?

Generally, patients were not familiar with palliative care. If they had heard of it, they often equated it with hospice or end-of-life care, leading to misconceptions about its scope and purpose.

However, our observations revealed that patients frequently initiated discussions about concerns relevant to palliative care, such as social or psychological burdens they were experiencing during their visits with surgeons. This indicated an underlying interest in these domains, even if they were not explicitly aware of how palliative care could address them.

When we presented patients with a comprehensive definition of palliative care, some were receptive to surgeons broaching those domains, while others preferred that surgeons focus only on their technical expertise.

Q: What are the real-world implications, particularly for patients?

Our hope is that surgical care teams take advantage of these insights to develop more tailored approaches to meet patients’ holistic needs. For instance, they could adopt flexible communication strategies in which surgeons engage patients in a manner that’s aligned with their comfort levels—broaching palliative care domains with patients open to having these conversations, while respecting the preferences of those who’d only like to discuss their operations.

These types of personalized tactics have the potential to improve patients’ outcomes and quality of life, ultimately fostering a more comprehensive and patient-centered surgical experience.

Authorship: In addition to Morton and Cooper, Mass General Brigham authors include Amanda Reich, Cameron Comrie, Orly Farber and Masami Tabata-Kelly. Additional authors include Weija Sun, Hiba Dhanani, Lyle Suh and Daniel Dohan.

Paper cited: Morton, C.., et al. “Patient Perceptions of Palliative Care in Surgery: A Qualitative Study.” Journal of Pain and Symptom Management. DOI: 10.1016/j.jpainsymman.2026.02.014

Funding: This study was supported by grants from the National Institute of Aging and the National Institutes of Health: (R38AG085422) and (R01AG070252).

Disclosures: None