title: Experience and attitudes of surgeons toward palliation in cancer.
abstract: BACKGROUND
  Surgery can effectively palliate symptoms in patients with advanced malignancy and thereby maintain quality of life. However, the goal of surgical palliation should be balanced with the associated risks, and the decision to operate can be challenging for even the most experienced surgeon.
  
  
  OBJECTIVE
  There are significant deficiencies in training during residency and in continuing medical education in palliative surgical care leading to a lack of agreement for treatment recommendations.
  
  
  METHODS
  A survey of general surgeons involving 4 clinical vignettes of patients with advanced malignancies and varying degrees of symptoms. Respondents were asked to select the best treatment option for each patient from a list of 6 alternatives. Furthermore, respondents identified the clinical factors that most influenced the decision, as well as the major goal of the palliative intervention.
  
  
  METHODS
  Surgeons in a midsized urban setting and its surrounding region.
  
  
  RESULTS
  Of 124 surveys sent out, 70 (56%) were completed. Significant deficiencies in education were identified; 59 (84%) of the respondents did not receive any education in palliative surgical care during residency and 28 (44%) lacked continuing medical education. A consensus treatment recommendation was not selected in 3 of the 4 clinical vignettes, but the respondents used similar clinical factors and goals of treatment for selection of the specific recommendation.
  
  
  CONCLUSIONS
  Palliative care is a major deficiency of postgraduate surgical training. A more focused effort in training surgeons in palliative care may allow for the more uniform and standard provision of palliative surgical care to patients with advanced cancer.
authors.affiliation: Department of Surgery, University of California, Davis, Medical Center, Sacramento 95817, USA.
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Galante
authors.forename: Tawnya L
authors.initials: TL
authors.lastname: Bowles
authors.forename: Vijay P
authors.initials: VP
authors.lastname: Khatri
authors.forename: Philip D
authors.initials: PD
authors.lastname: Schneider
authors.forename: James E
authors.initials: JE
authors.lastname: Goodnight
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Bold
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003657:Decision Making; D004501:Education, Medical; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000601:surgery*; D010166:Palliative Care / Q000379:methods* / Q000523:psychology