Understanding shared decision making about high risk surgery
Research type
Research Study
Full title
Understanding decision making about high risk surgery: a qualitative study of shared decision making by patients and their clinical teams
IRAS ID
256208
Contact name
Sara Shaw
Contact email
Sponsor organisation
University of Oxford / Clinical Trials and Research Governance
Duration of Study in the UK
1 years, 6 months, days
Research summary
Summary of Research
This research seeks to extend our understanding of shared decision-making practices for patients contemplating high risk surgery. Our focus is deliberately on patients contemplating one of three major surgical procedures: major joint surgery, intra-abdominal surgery and cardiac surgery, and on understanding how the motivations, expectations and communicative approaches of patients, their doctor and (where appropriate) carers or families combine to shape decisions about treatment. Drawing on a combination of individual and focus group interviews with observation of shared decision making encounters between patients and their clinicians, our aim is to identify the key influences on the shared decision making process. Findings from the study will include a typology of shared decision making scenarios for major surgery and revised theory, both of which are intended to inform a wider programme of research on Optimising Shared decisIon-making for high RIsk major Surgery (OSIRIS) funded by the National Institute for Health Research.Summary of Results
Three types of consultation about major surgery were identified (Table 2). The extent to which decision-making was shared was influenced by presenting problem, clinical pathway and patient trajectory. Resolution-focused consultations resulted in a single agreed preferred option related to a potentially life-threatening presenting problem. Evaluative consultations focused on assessing the likelihood of benefits of surgery for a presenting problem which was not the most significant threat to life for the patient at the time. Deliberative consultations involved discussion of a range of options identified in attempting to balance the need to address the presenting problem in light of significant comorbidities and patients’ preferences.
Conclusions: Decisions about major surgery are not always shared. The nature of the presenting problem, comorbidities, clinical pathways, patient trajectories and organisational setting all guide the type of consultation that will happen and propensity for sharing decision-making. Shared decision-making about major surgery is most feasible when the course of action is framed as being about deciding on life-enhancing rather than life-saving treatment.REC name
South Central - Oxford C Research Ethics Committee
REC reference
19/SC/0043
Date of REC Opinion
5 Feb 2019
REC opinion
Favourable Opinion