Evidence based and patient centred information for surgery
Surgical care goes beyond the operating theatre. Discussions about the benefits and risks of surgery is a core component of surgical care in the NHS and of utmost importance to patients and their carers. This theme aims to optimise shared decision-making and informed consent in surgery through an in-depth understanding of discussions between patients and surgeons, developing recommended best practice and investigating the impact of communication interventions.
Core information sets
We have led methodological work to identify the high-quality core information rated most important by patients and clinicians to stimulate individualised discussions with patients undergoing surgery. Core information sets have been developed for colorectal, head and neck and oesophageal cancer surgery and studies are planned to investigate how best to implement and evaluate these sets in clinical practice.
Work to develop a core information set for surgical innovation is currently underway.
Informed consent for novel surgery
There is little evidence that surgeons routinely discuss the “novelty” of surgical innovation in a way that supports patients making an informed treatment choice. Typically, surgeons are overly optimistic about the benefits of new treatments and underestimate the harms, thereby encouraging the view that “new” surgery means the same as “better” surgery.
We are developing ways to optimise the informed consent process for new surgery. In-depth interviews with patients and surgeons will identify key issues around the communication of risks and harms, and real-life consultations recorded to identify areas of best practice. Methods to improve communication will then be tested and evaluated in the clinical setting.
Through the Lotus study we are using ethnographic research methods to follow case studies of different innovative invasive procedures and devices in different clinical specialities over time. The data collected captures current practice on information provision to patients regarding innovative and modified procedures, subsequent decision-making and (un)informed consent for the procedures. Analysis of the data has revealed the challenges inherent in the process as well as unique opportunities for improved information provision and informed consent. Further details available here.
The QuinteT Recruitment Intervention (QRI) aims to understand and optimise recruitment and has been integrated into over thirty nationally funded feasibility, pilot and full RCTs. The team use novel qualitative methods, such as recording interactions between patients and healthcare professionals, to understand how new surgical procedures are introduced in the Surgical Innovation workstream on ‘Informed consent for new and evolving surgeries’ within the NIHR Bristol Biomedical Research Centre.
Information for end of life care
The Lancet has created a commission on The Value of Death, with a global focus on the medicalisation and possible de-medicalisation of death. This intriguing commission aims to explore variations in cultural approaches to death and dying.