Operative vs non operative care for NELA-eligible patients
Research type
Research Study
Full title
Shared decision-making and Treatment Escalation Plan in emergency laparotomy for operative and non-operative patients: Understanding Perspectives and examining outcomes (STEP-UP)
IRAS ID
346378
Contact name
Joyce Yeung
Contact email
Sponsor organisation
University of Warwick
Duration of Study in the UK
1 years, 4 months, 30 days
Research summary
Emergency laparotomy (EL) is a major surgery needed urgently for life-threatening abdominal conditions. However, deciding whether to proceed with surgery can be challenging due to its high risks, potential complications, and prolonged recovery.
Sometimes, despite the need for EL, patients and doctors decide against surgery. This is called a ‘NoLap’ decision, which may be based on a patient’s preferences, health condition they have make the operation too risky, or the underlying problem is too severe for surgery. These decisions are difficult when time is limited, or the patient is too unwell to express their wishes.Little is known about NoLap patients, their outcomes, and their care preferences. Our project aims to address this gap and improve care for them.
Our study has two parts:
Workstream 1: Cohort study
Using data from the National Emergency Laparotomy Audit, we will compare outcomes of NoLap patients and those who underwent EL. We will examine outcomes such as 30-day survival rates, hospital readmissions, and involvement of healthcare teams in their care. Understanding these differences will help with shared decision-making (SDM) between clinicians and patients in conditions when EL is required.Workstream 2: Interview study
We will interview patients, caregivers, and healthcare professionals to understand their experiences with SDM and treatment escalation planning (TEP). TEP outline patients’ wishes during emergencies but are often not discussed due to the sensitivity of these conversations. We aim to identify barriers to these discussions and explore ways to make them more effective.With an ageing population and increasing health complexities, surgery may not always be the best option. By understanding NoLap patients and their care preferences, we aim to support better decision-making, improve care, and empower patients to take control of their health. Informed decisions can help reduce regret and enhance patient satisfaction with their care.
REC name
Wales REC 4
REC reference
26/WA/0023
Date of REC Opinion
21 Apr 2026
REC opinion
Further Information Favourable Opinion