Perioperative Integration of Palliative Care and Urology for Patients With Serious Urologic Illness: A Qualitative Need Finding Inquiry.

Maheta BJ, Singh NK, Bergman J, Brown-Johnson CG, Gunturi A, Interrante N, Leppert JT, Lorenz KA, Raspi IG, Giannitrapani KF. Perioperative Integration of Palliative Care and Urology for Patients With Serious Urologic Illness: A Qualitative Need Finding Inquiry. Journal of pain and symptom management. 2025 Jun 1; 69(6):603-610.e6, DOI: 10.1016/j.jpainsymman.2025.02.472.

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Abstract:

CONTEXT: Many urologic serious illnesses are treated with surgical procedures, which may put patients at a further risk of diminished quality of life. OBJECTIVE: To understand stakeholder perceptions on integrating perioperative Palliative Care (PC) for patients with serious urologic illness. METHODS: We conducted semi-structured interviews and team-based thematic analysis to consensus with a dual review. Purposefully sampled urologists, palliative care physicians, and clinical team members at fourteen geographically distributed Veteran Health Administration sites were interviewed. RESULTS: We identified one general overall theme, to "change culture" so that PC is not a "last resort," and three opportunities along the perioperative continuum for integrating urology and PC. Opportunity 1: Utilizing telehealth and team member role expansion when discussing the initial diagnosis, with surgery as a potential treatment option, allows for multiple conversations "so they''re not rushed in 15 minutes to mentally deal with the new diagnosis." Opportunity 2: Creating a process to ensure goal of care conversations occur, since "urologic procedures can have complications that significantly impact quality of life," which "would require changing how our workflow is structured." Opportunity 3: During the preoperative visits, interdisciplinary input and evaluation of the patient prior to surgery allows the patient to "have a sort of joint meeting with us and the urologist." This represented the last point in time to de-escalate and offer nonsurgical options prior to surgery. CONCLUSIONS: The study informs future interventions to improve the quality of surgical care by integrating PC with urology in a unified workflow.