Between a Rock and a Hard Place: Anticipating Poor Surgical Outcomes While Honoring Patient Autonomy

This chapter identifies barriers to patient-centered care in those nearing the end of life, explores best practices for addressing surgical expectations in high-risk patients and integrating palliative care into the interdisciplinary perioperative team, and discusses potential adverse effects of current surgical quality metrics and their effect on the surgeon. We propose an enhanced model for palliative care involvement in surgical care for patients at the end of life which includes support for the patient and surgeon to maintain a patient-centered approach and lessen the emotional toll of unexpected outcomes.