Surgeons lack training in palliative surgical options

09/15/05

CHICAGO A survey of general surgeons suggests that the amount of education and training they receive in palliative care is limited, according to a study in the September issue of Archives of Surgery, one of the JAMA/Archives journals.

Previous studies have indicated that surgeons receive little training in palliative surgical intervention, the objective of which is to relieve symptoms and improve quality of life rather than cure disease or extend survival, according to background information in the article. Because the goals of surgical palliation must be balanced with the associated risks of surgery, the decision to operate can be challenging for even the most experienced surgeon. Deficiencies in training during residencies and insufficient education in the evaluation of surgical options when there is not much hope of cure may contribute to a lack of consensus treatment recommendations for patients with advanced cancer and a variety of common symptoms, the authors suggest.

Joseph M. Galante, M.D., of the University of California, Davis, Medical Center, Sacramento, Calif., and colleagues surveyed 124 surgeons in Sacramento, and the surrounding area about the type and extent of their postgraduate education in palliative surgery. The surgeons were also asked to select the single best treatment option from a preset list for four clinical scenarios and to identify the goals of the intervention and the three most important factors influencing their decision.

"Significant deficiencies in education were identified; 59 (84 percent) of the [70] respondents did not receive any education in palliative surgical care during residency and 28 (44 percent) lacked continuing medical education," the authors report. "A consensus treatment recommendation was not selected in three of the four clinical vignettes, but the respondents used similar clinical factors and goals of treatment for selection of the specific recommendation.

"Part of the lack of a standard approach to palliative surgical care in patients we identified may be based on the fact that physicians receive their training and experience in palliative care from diverse sources at various stage in their careers," the authors write.

"In conclusion, although most surgeons have similar goals in providing palliative care, treatments recommended may vary significantly," the authors write. "Furthermore, prior education clearly affects the recommended treatment option to achieve palliation of disease-related symptoms in patients with advanced malignancies. Thus, we advocate a continued effort to train surgeons in palliation and recommend that the training be part of a nationwide program to standardize palliative surgical care."

(Arch Surg. 2005; 140:873-880. Available pre-embargo to the media at www.jamamedia.org.)

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