This study offers an arts-based tool set capable of being delivered within the familiar medical education setting and established structure of the OSCE.

Justification for using WTP values and QALYs lies in incorporating preferences of those whose treatment could be affected.

When surgical intervention is most appropriate, success should be defined by how well a surgical intervention aligns with a patient’s goals.

For some patients whose survival is extended by disease-modifying interventions, little guidance about clinical and ethical complexities exist.

Priorities far beyond generating morbidity or mortality data are needed to improve patients’ experiences, innovate metrics, and advance surgical palliation as a field.

Seeming incongruity between surgery and palliation reiterates patients’ needs for clinicians to be able to identify when and how they should coexist.

A surgeon’s duty is to identify goals of care, including those about quality of life, from a patient’s perspective and to consider how to achieve them.

Health educators have duties to teach patient focus, motivate equity, and cultivate students’ capacity to serve our most vulnerable neighbors, wherever they reside.

No single person should make decisions about for whom or according to which criteria palliative surgery is clinically and ethically appropriate.

Differentiating between best palliative care options and the curative and palliative potential of surgery is key to developing dual intentional clarity.