Strategies to Improve Perioperative Palliative Care Integration for Seriously Ill Veterans

Context. Seriously ill patients are at higher risk for adverse surgical outcomes. Palliative care (PC) interventions for seriously ill surgical patients are associated with improved quality of patient care and patient-centered outcomes, yet, they are underutilized perioperatively.Objectives. To identify strategies for improving perioperative PC integration for seriously ill Veterans from the perspectives of PC providers and surgeons.Methods. We conducted semistructured, in-depth individual and group interviews with Veteran Health Administration PC team members and surgeons between July 2020 and April 2021. Participants were purposively sampled from high- and low-collaboration sites based on the proportion of received perioperative palliative consults. We performed a team-based thematic analysis with dual coding (inter-rater reliability above 0.8).Results. Interviews with 20 interdisciplinary PC providers and 13 surgeons at geographically distributed Veteran Affairs sites converged on four strategies for improving palliative care integration and goals of care conversations in the perioperative period: 1) develop and maintain collaborative, trusting relationships between palliative care providers and surgeons; 2) establish risk assessment processes to identify patients who may benefit from a PC consult; 3) involve both PC providers and surgeons at the appropriate time in the perioperative workflow; 4) provide sufficient resources to allow for an interdisciplinary sharing of care.Conclusion. The study demonstrates that individual, programmatic, and organizational efforts could facilitate interservice collaboration between PC clinicians and surgeons. J Pain Symptom Manage 2023;66:621-629. Published by Elsevier Inc. on behalf of American Academy of Hospice and Palliative Medicine.

Automated summary

This study identifies four strategies to improve palliative care integration and goals of care conversations in the perioperative period for seriously ill Veterans, including building collaborative relationships, establishing risk assessment processes, involving both PC providers and surgeons at the appropriate time, and providing sufficient resources for interdisciplinary care sharing.