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Palliative care is commonly misinterpreted as solely being for people who are dying, yet it can help anyone who is suffering from a serious or complex illness. Its main objective is to improve the health or quality of life of a patient, and it may include surgery. However, when it comes to surgery, doctors sometimes argue over whether it's essential.

Researchers utilised the hypothetical case of a guy with a slowgrowing facial tumour that cannot be totally removed and will eventually kill him to see how the patient and physician may work together to determine if surgery would be beneficial [1,2].

When Surgery is an Option

"If a patient with decision-making capacity insists on a treatment that is neither safe nor indicated," the authors write, "a practitioner must refuse to deliver the requested therapy." "However, if a patient with decision-making capacity refuses treatment, a clinician must respect the patient's autonomy and cannot impose treatment."

Both circumstances, on the other hand, are on different ends of the spectrum, making judgments in the middle more challenging. Furthermore, deciding what is safe is dependent on the willingness of both the patient and the practitioner to accept risk.

According to the authors, palliative surgery adds another layer of risk.

"Measurements that characterise effective results are often more sophisticated," they stated. "Traditional indicators like as overall survival and disease-free survival are being pushed aside in favour of symptom management and quality of life."

The storey, however, does not end there. To address their complex disease processes, palliative care patients may require highly individualised therapy techniques [3].

"As the arsenal of systemic treatments, minimally invasive operations, endoscopic procedures, and percutaneous interventions for supportive care has grown, the selection of appropriate palliative therapy has become more complicated."

Things to Balance

The impact of surgery must be evaluated, according to the authors, because "the degree of risk that patients at the end of life are willing to bear for a procedure that they believe is safe varies and is dependent on their goals and preferences." "Thinking about which option will have the most positive influence will assist to explain these complex situations."

They went on to state that keeping the concept of value in mind is important because "it determines the range of options available to a patient and can improve decision-making."

They then mentioned the three most important decision-making criteria.

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The degree to which the symptoms are severe: Is the patient experiencing severe and widespread symptoms that could improve his quality of life if alleviated? For example, the patient may be housebound as a result of his condition, which has necessitated several hospitalizations [4,5].

Objectives of care: If patients realise they won't live much longer, they may have end-of-life goals that influence their decision-making. For example, the patient might want to pay a visit to a loved one.

The importance of surgery: It has the potential to improve the patient's quality of life by controlling his symptoms. If the patient survives and leaves the hospital, he may have time to enjoy the benefits of his procedure, depending on his condition.

Palliative surgery costs, on the other hand, are not insignificant and include resource consumption. Even if the treatment is for a long time, concerns about resource use should probably not take precedence over patient liberty.