An unexpected preoperative conversation, a new perspective on palliative care research

Abstract

During the course of recruitment for a randomized control trial, the author encounters a patient who changes her perspective on research and who inspires her to continue work in the field of palliative care. The author describes this encounter and her reflections regarding it using quotations from the patient's presurgical consent visit for major surgery with his surgeon and wife. The author explores the layers of complexity in the preoperative visit--the patient's changing medical condition, patient-companion relationship, and patient-provider relationship--that lead to a reconsideration of whether to proceed with surgery. Advance care planning and goals of care are explored unexpectedly, wherein the patient must weigh surgical risks with quality of life considerations. The piece's focus on shared decision making towards end of life reinforces the value of discussing these topics before major surgery and in complicated cases.

Keywords: Cancer; Companion/caregiver; Decision-making; Oncology; Patient-provider communication; Surgical care.