CONCLUSION
For the present, cultural and attitudinal change in the surgical ICU may be promoted by
several strategies. One is to call attention to efforts by surgeons themselves such as those of
the American College of Surgeons’ Surgical Palliative Care Task Force. Surgeons listen
closely to other surgeons. It is also important to emphasize that palliative care can and will
be provided together with, not instead of, an aggressive care plan including the use of all
appropriate surgical intensive care therapies. To convey this message credibly and
effectively, specialists in palliative care and in critical care need to be respectful and
supportive of goals of care that are established by primary surgical physicians with patients
and their families. There are already data that high-quality palliative care in the ICU does
not increase ICU or hospital mortality (21, 35, 52). In fact, recent data suggest that early
integration of palliative care with disease-directed care of patients with serious illness may,
in some diseases, prolong life (53, 54). These data should be reviewed with surgical
professionals. In addition, other members of the care team who work with surgeons in the
ICU should be educated about surgeons’ perspectives on palliative care and the
psychological, personal, and practical factors that shape it. The value of the surgeon’s
profound commitment to achieving the best possible outcome for his or her patient and
loved ones should be recognized as well. The collaboration of palliative care specialists and
critical care staff with surgeons is essential to enhance palliative care. In an open discussion
involving the full interdisciplinary team, surgeons as well as others can be given an
opportunity to voice their concerns about integrating palliative care more fully in the ICU
and contribute to development of strategies for this purpose.