• Brendan R Dillon, Mark A Healy, Christina W Lee, Ari C Reichstein, Maria J Silveira, Arden M Morris, and Pasithorn A Suwanabol.
• 1 University of Michigan Medical School, Ann Arbor, Michigan.
• J Palliat Med. 2019 Feb 1; 22 (2): 132-137.

BackgroundSurgical patients most commonly receive palliative care services within 24-48 hours of death, and reasons for this delay are poorly understood. Research with nonsurgeons suggests that physician characteristics and beliefs about death and dying may contribute to late referral.ObjectiveTo describe surgeon perspectives related to death and dying, and their relationship with delayed referrals to palliative care.DesignUsing a previously validated survey instrument supplemented by open-ended questions, deductive content analysis was used to describe surgeon preferences for end-of-life care.SettingsParticipants were all current nonretired members of the American Society of Colon and Rectal Surgeons.Main Outcome MeasuresSurgeon descriptions of a "good death" and how personal experiences influence care provided.ResultsAmong 131 survey respondents (response rate 16.5%), 117 (89.3%) completed all or part of the qualitative portion of the survey. Respondents consistently reported their personal preferences for end-of-life care, and four central themes emerged: (1) pain and symptom management, (2) clear decision making, (3) avoidance of medical care, and (4) completion. Surgeons also reflected on both good and bad experiences with patients and family members dying, and how these experiences impact practice.LimitationsThe small sample size inherent to Internet surveys may limit generalizability and contribute to selection bias.ConclusionThis study reveals surgeon preferences for end-of-life care, which may inform initiatives aimed at surgeons who may underuse or delay palliative care services. Future studies are needed to better understand how surgeon preferences may directly impact treatment recommendations for their patients.

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