Surgeons are missing crucial opportunities to integrate palliative care for seriously ill older patients undergoing elective surgeries.

• Palliative care practices were infrequently utilized, despite their importance.
• Clinicians from various surgical fields acknowledged alignment with palliative care, but many felt it conflicted with their role.

Surgeons often prioritized technical issues over patients’ psychosocial concerns, indicating the need for improved communication.

• Reframing the surgical identity could bridge gaps between surgical and palliative care objectives.