Development of surgical palliative care as a field and community building in palliative care: past, present, and future directions

Abstract

The professionalization of hospice and palliative medicine has been well documented, as has its associated rise to specialty status. The movement to formalize hospice and palliative medicine in the United States included ten sponsoring boards for initial certification through a practice pathway. Thus, it began with the potential for subspecialty interests, advocacy, and training. This review will examine the emergence of surgical palliative care as a field within hospice and palliative medicine as well as its unique place within the specialty of surgery, where it is sometimes hailed as an inherent, historically present body of knowledge and skill, and just as often, remarked upon as an ahistorical oxymoron. The phases of formation, early adoption, popularization, and normalization will be described and illustrated by the benchmarks of formal education requirements, board eligibility and certification, and professional relationships fostered by medical societies and online communities. Community building in palliative care must acknowledge the diversity of its constituents and the differences in subspecialty identity formation and sources of professional credibility and legitimacy. Metaphors for practitioners of surgical palliative care range from the rarity of the unicorn to the swarm intelligence principles of the beehive. Future directions include facing the questions about the role of specialty training and practice in surgical palliative care compared to renewed emphasis on palliative principles in general surgical training and practice.