Surgical Palliative Care Exchange

Code, Cut, or Comfort: Goal-Concordant Care

A facilitated module on connecting surgical options, expected recovery, and uncertainty with what matters most to a patient.

Prototype in review · not yet available

Overview

When an operation is possible but its benefit is uncertain, patients and families need more than a technical answer. This module helps learners describe what each option could mean for daily life, explore what matters to the patient, and offer a recommendation that connects the two.

It also makes a point learners often miss: the surgeon’s role continues when an operation isn’t chosen. Resuscitation preferences, operative decisions, and the overall goals of care are related but separate conversations, and palliative care can accompany surgery.

Learning objectives

  1. Describe the surgeon’s contribution when an operation is uncertain or not chosen.
  2. Discuss recovery and uncertainty in terms that connect with a patient’s priorities.
  3. Practice a recommendation that links the available options to those priorities.

Audience and duration

Audience
Surgery and emergency medicine residents, practicing surgeons, and interprofessional educators who teach serious-illness care. Students can take part with extra support.
Teaching time
20–25 minutes, including four minutes of paired practice. This is the designed length; the module hasn’t been test-taught yet.
Format
Facilitated slides with discussion and paired practice

Teaching materials

Not yet available. The slides and guide will appear here once the final version and its sharing permissions are approved.

What the module will include:

  • 19 slides with speaker notes: 17 for teaching and 2 for references
  • A wholly fictional case and practice dialogue, written for teaching
  • A four-minute paired practice, debrief questions, and a short knowledge check

Educator guide

A four-page guide for whoever is teaching: preparation, facilitation notes for each part of the session, an observable-feedback checklist for the paired practice, and the knowledge-check answer with its reasoning. The suggested run of show:

  1. Slides 1–4Purpose, the fictional case, and an opening question3–4 min
  2. Slides 5–7Shared decisions and surgical prognosis4 min
  3. Slides 8–13Language, comfort care, collaboration, and time-limited trials6–7 min
  4. Slide 14Paired practice4 min
  5. Slides 15–17Debrief, knowledge check, and closing3–4 min

Contributor credits

Adapted from teaching by Heather Logghe, MD, first presented at combined surgery and emergency medicine grand rounds in June 2025.

Final credits and a recommended citation will be added before release.

References

Citation review is pending; links will be added once it’s complete.

  1. American College of Surgeons. Optimal Resources for Geriatric Surgery: 2019 Standards. Standard 5.1.
  2. Kon AA, Davidson JE, Morrison W, et al. Shared decision making in ICUs: an American College of Critical Care Medicine and American Thoracic Society policy statement. Critical Care Medicine. 2016;44(1):188–201.
  3. Taylor LJ, Nabozny MJ, Steffens NM, et al. A framework to improve surgeon communication in high-stakes surgical decisions: Best Case/Worst Case. JAMA Surgery. 2017;152(6):531–538.
  4. Ariadne Labs. Serious Illness Conversation Guide. Revised May 2023.
  5. American College of Surgeons. ACS TQIP Palliative Care Best Practices Guidelines. 2017.
  6. Kruser JM, Ashana DC, Courtright KR, et al. Defining the time-limited trial for patients with critical illness: an official American Thoracic Society workshop report. Annals of the American Thoracic Society. 2024;21(2):187–199.
  7. American College of Surgeons. Statement of Principles of Palliative Care. 2005.

Review date and reuse permissions

Version
Prototype 0.1, October 2026
Clinical review
Not yet reviewed
Corrections
A way to send corrections will be added here before release.

Each kind of reuse is decided separately, for this resource only.

  • LinkNot yet decided
  • HostNot yet decided
  • DownloadNot yet decided
  • AdaptNot yet decided

Until permissions are listed here, please don’t copy, share, or adapt these materials.

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An independent educational project, initiated and curated by Heather Logghe, MD. Organizational affiliations don’t imply sponsorship or endorsement. These materials support teaching and don’t replace clinical judgment for a particular patient.