Shaw Sara, Hughes Gemma, Stephens Tim, Pearse Rupert, Prowle John, Ashcroft Richard Edmund, Avagliano Ester, Day James, Edsell Mark, Edwards Jennifer, Everest Leslie
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
BMJ Open. 2020 May 5;10(5):e033703. doi: 10.1136/bmjopen-2019-033703.
Surgical treatments are being offered to more patients than ever before, and increasingly to high-risk patients (typically multimorbid and over 75). Shared decision making is seen as essential practice. However, little is currently known about what 'good' shared decision making involves nor how it applies in the context of surgery for high-risk patients. This new study aims to identify how high-risk patients, their families and clinical teams negotiate decision making for major surgery.
Focusing on major joint replacement, colorectal and cardiac surgery, we use qualitative methods to explore how patients, their families and clinicians negotiate decision making (including interactional, communicative and informational aspects and the extent to which these are perceived as shared) and reflect back on the decisions they made. Phase 1 involves video recording 15 decision making encounters about major surgery between patients, their carers/families and clinicians; followed by up to 90 interviews (with the same patient, carer and clinician participants) immediately after a decision has been made and again 3-6 months later. Phase 2 involves focus groups with a wider group of (up to 90) patients and (up to 30) clinicians to test out emerging findings and inform development of shared decision making scenarios (3-5 summary descriptions of how decisions are made).
The study forms the first part in a 6-year programme of research, Optimising Shared decision-makIng for high-RIsk major Surgery (OSIRIS). Ethical challenges around involving patients at a challenging time in their lives will be overseen by the programme steering committee, which includes strong patient representation and a lay chair. In addition to academic outputs, we will produce a typology of decision making scenarios for major surgery to feed back to patients, professionals and service providers and inform subsequent work in the OSIRIS programme.
接受外科手术治疗的患者比以往任何时候都多，而且越来越多的是高危患者（通常患有多种疾病且年龄超过75岁）。共同决策被视为必不可少的做法。然而，目前对于“良好”的共同决策包括哪些内容，以及它如何应用于高危患者的手术背景下，人们知之甚少。这项新研究旨在确定高危患者、其家属和临床团队如何就重大手术的决策进行协商。
以大型关节置换术、结直肠手术和心脏手术为重点，我们使用定性方法来探究患者、其家属和临床医生如何就决策进行协商（包括互动、沟通和信息方面以及这些方面被视为共同参与的程度），并反思他们所做的决策。第一阶段包括对患者、其护理人员/家属和临床医生之间关于重大手术的15次决策过程进行录像；在做出决策后立即以及3至6个月后，对相同的患者、护理人员和临床医生参与者进行多达90次访谈。第二阶段包括与更广泛的患者群体（多达90人）和临床医生群体（多达30人）进行焦点小组讨论，以检验新出现的研究结果，并为共同决策情景的制定提供信息（对决策过程的3至5个简要描述）。
该研究是为期6年的研究项目“优化高危重大手术的共同决策”（OSIRIS）的第一部分。在患者生命中的艰难时刻让患者参与所带来的伦理挑战将由项目指导委员会监督，该委员会包括强大的患者代表和一名非专业主席。除了学术成果外，我们还将制作一份重大手术决策情景类型，反馈给患者、专业人员和服务提供者，并为OSIRIS项目的后续工作提供信息。
