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Flash Presentation

Clinical Ethics

Session: Flash Session: Clinical Ethics Consultations

A scoping review on goals of care discussions in surgery: How are we doing and how can we do better?

Saturday, October 25, 2025
8:00 AM - 9:00 AM Pacific Time
Location: A103-104
Yerin Lee, BSc – Temerty Faculty of Medicine – University of Toronto; Selena Zhang, BSc – Temerty Faculty of Medicine – University of Toronto; Abu Sadat Mohammad Nurunnabi, MHSc – Joint Centre for Bioethics – University of Toronto; Marina Englesakis, MLIS – Library and Information Services – University Health Network; Karen Devon, MDCM MSc – Endocrine Surgeon, Division of General Surgery, Department of Surgery, University of Toronto
Abstract:

Purpose: We conducted a scoping review to characterize the existing literature on the quality of goals of care (GOC) discussions in surgery. We identify gaps in how surgeons conduct GOC discussions with patients and propose strategies for improvement.

Methods: MEDLINE, MEDLINE In-Process/ePubs, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Web of Science, Scopus and ClinicalTrials.Gov were searched using terms related to GOC, surgery, and best practices or education. The search strategy was run from inception to July 29, 2022. We included studies that discussed the quality of GOC discussions in surgical settings.

Results: The search identified 14,254 articles from which 37 were included for review. Most studies originated from North America and focused on eliciting the perspectives of surgeons. Key findings were: (1) the reactive nature of GOC discussions and propensity to initiate conversations in response to acute health changes, (2) ambiguity around the extent of patient autonomy and the surgeon’s responsibility to prioritize surgical treatment, (3) surgeons as gatekeepers of information, and (4) tendency of surgeons to provide a list of care options and determine specific care decisions rather than establish understanding of patients’ long-term goals. Education for surgeons on how to balance clinical opinion with patient autonomy, elicit patient perspectives on what constitutes a meaningful life, and manage implicit biases around patient readiness for raising difficult topics will improve GOC discussions.

Conclusions: Findings have important implications for improving GOC discussions in surgical settings and ensuring that these conversations are conducive to patient-centred care.

Keywords: goals of care, surgery, patient autonomy

Learning Objectives:

After participating in this conference, attendees should be able to:
  • Identify aspects of goals of care discussions in surgical settings that require improvement.
  • Discuss factors that initiate, hinder, and shape goals of care discussions in surgery, and the various roles involved in facilitating these conversations.
  • Describe areas of future research to expand our understanding of patient-centred care in surgery.