ABSTRACT
The ever-widening clinical spectrum of palliative care requires the inclusion of surgery and surgeons to assure informed decision-making, symptom control, and improvement of quality of life (QOL). Few surgeons would dispute the relevance of these tasks to their practices though considerable ambivalence remains for many about pursuing these as primary goals of care. Adding to their reluctance to endorse palliative care is the stunning progress that has been made in the amelioration or eradication of many chronic and fatal illnesses. This ambivalence can be understood as the expression of multiple barriers to the acceptance of palliative care as a clinical framework of care that replaces the disease-directed or “cure”-based model of care. The barriers can be classišed as cognitive, psychological, socioeconomic, and spiritual, which roughly align them with the four principal domains of “total pain” described by Dame Cicely Saunders.
