On last January 2, JAMA Surg. published a report titled Palliative Care and End-of-Life Outcomes Following High-Risk Surgery (Original investigation). The issue has bioethics implications and is a matter that concerns the difficulty of access to adequate palliative care even in developed countries. In fact, it is a biomedical priority often postponed even by the World Health Organization (WHO), (see Why is not palliative care included in WHO Universal Health Coverage (UHC) goals?).

Concept of adequate palliative care

The authors begin with a question, What is the role of palliative care in the care of patients undergoing high-risk surgery and the association between palliative consultations and end-of-life outcomes of patients who died after surgery?

Methodology

The study analyzed the use of perioperative palliative care and its association with family-reported end-of-life experiences of patients who died within 90 days of a high-risk surgical operation. It was conducted in the Department of Veterans Affairs (VA) Healthcare System. Patients who underwent any of 227 high-risk operations a total of 95 204 patients in the three years study.

More relevant results

  • The 90-day mortality rate was 6.0% (5740 patients) varied by surgical subspecialty.
  • A multivariate mixed model revealed that families of decedents ( deceased person) who received palliative care were 47% more likely to rate overall care in the last month of life as excellent than those who did not. Of the entire cohort (95204),
  • 3374 patients (3.75%) had a palliative care consultation, and
  • 770 patients (0.8%) received it before surgery. Of all decedents,
  • 1632 (29.9%) had a palliative care consultation, with 319 (5.6%) receiving it before surgery.

Conclusions and Relevance

The authors concluded that “Receipt of a palliative consultation was associated with better ratings of overall end-of-life care, communication, and support, as reported by families of patients who died within 90 days of high-risk surgery” but pointed out that Only one-third of the decedents were exposed to palliative care.”

As a final comment, the authors suggested that “Expanding integration of perioperative palliative care may benefit patients undergoing high-risk operations and their families.”

A bioethical and humanitarian approach

From a bioethical point of view are urgent humanize end of life care and significant improvement in palliative care. The WHO’s UHC (Universal Health Coverage) should urgently include adequate palliative care from the diagnosis to palliative care units with a specialized and trained multidisciplinary team of medical professionals.