“the palliative triangle” in surgery

When I was a medical student, I rotated on the surgical oncology floor. Day after day, we rounded at the break of dawn on patients with grim prognoses: hepatic encephalopathy after a Whipple procedure, patients on TPN because of total obstruction due to gastric carcinoma, patients with non-healing open wounds who developed sepsis.

We noted their complaints of pain, their increasingly abnormal labs, their poor intake and bewildered family members at the bedside. And then we moved on to the next patient.

What I concluded was that the surgery teams were among the most reluctant to discuss palliative care with their patients, because of what it implied: failure to solve the problem. We weren’t able to resect 100% of the tumor. We found extra positive lymph nodes we didn’t expect. We weren’t able to cure you.

However, the World Health Assembly has stated that palliative care is “an ethical responsibility…irrespective of whether the disease or condition can be cured.”

A concept called “the palliative triangle” has emerged as a helpful way to conceptualize how palliative care can be provided in the surgical setting. Studies show that patients who received palliative surgery actually had prolonged survival and fewer post-op complications compared to patients who received surgeries intended to cure.

 

Have you been part of a good palliative care discussion with a surgical patient? What made it successful?

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About the friendly intern

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