Exploring patient perspectives of informed consent and decision making in innovative procedures

Motif

Supervisors

  • Dr Daisy Elliott – Research Fellow, Bristol Medical School with expertise in qualitative methodology, surgical innovation and informed consent
  • Dr Leila Rooshenas – Senior Lecturer in Qualitative Health Science, Bristol Medical School with expertise in surgical innovation, treatment decision-making and health services research
  • Dr Kerry Avery – Associate Professor in Applied Health and Care Research, Bristol Medical School with expertise in surgical innovation and patient-centred outcomes

Theme

Surgical and orthopaedic innovation 

Keywords

Informed consent, qualitative, patient 

Background

Surgical innovation is key to improving patients’ quality and length of life. Updated guidance from the General Medical Council on decision-making and consent states that patients must be informed if a treatment option is innovative. Research suggests, however, that information given to patients can vary considerably in content and quality. An inquest into the death of the first patient in the UK to undergo robotically assisted heart surgery found that the patient had not been informed about the risk of robotic versus conventional open heart surgery. An independent national safety review led by Baroness Cumberlege heard evidence that highlighted deficiencies in how informed patients are before undergoing new surgical procedures. There is an urgent need to address these issues, to improve patient consent and patient care. 

The Lotus study collaborates with surgical teams and patients to follow ‘case studies’ of innovation in detail(1). This includes audio-recording patient-surgeon interactions and conducting interviews with patients and surgeons about their experiences. To date, the team have followed nine innovative procedures in eight hospitals, with over 100 patients recruited. We hope to appoint a PhD student to focus on the patient-focused elements of the Lotus study. The student will work across several case studies of new surgical procedures as an integral member of the research team. They will have responsibility for conducting patient interviews within the selected case-studies. The findings of these interviews will be analysed and synthesised to form the basis of a PhD thesis that explores patients’ decision-making around innovative procedures and techniques. The PhD and its findings will be an important step in contributing to developing training and guidance for healthcare professionals that aims to improve decision-making and consent for new surgical procedures. 

Aims and objectives

This studentship aims to explore patient perspectives of informed consent and decision making in innovative procedures. This research will be conducted across a range of Lotus case studies, with a view to informing training materials that can be used by healthcare professionals to improve the way in which they approach decision-making and consent with patients undergoing innovative surgery. There will be opportunities for the successful candidate to develop and refine research objectives in collaboration with their supervisors.

These objectives may include:

  1. Development and implementation of a research study protocol, including methods for linking the analysis of audio-recorded surgeon-patient discussions and subsequent patient interviews
  2. Implementation of this protocol across a range of case studies, with a view to exploring how clinicians’ explanations of innovative procedures are interpreted by patients
  3. Iterative development of healthcare professional training/guidance materials, based on findings from ‘b’ and concurrent evaluation. 

Methods

It is anticipated that the PhD student will first conduct a qualitative synthesis of papers that have explored the patient perspective in the context of innovative invasive procedures. Consultations in which an innovative procedure is discussed will be audio-recorded to understand information provision practice. Post-operative interviews will then be conducted with patients who are eligible for the intervention. Interviews will explore views on the presentation of information provided about the procedure during consultations, reasons underlying decisions to accept or decline the procedure, views/understanding of innovation and (if relevant) their experience of undergoing the procedure and subsequent recovery. Triangulation of these multiple data sources will provide important insights into patients’ perspectives of decision-making and consent for innovative surgical procedures. The project will aim to follow a range of case studies to capture innovation in different contexts, including varying stages of innovation, type of innovation (surgical procedure or medical device), surgical specialty, and NHS trust type (e.g. geographical area, foundation status and acute trust type).  

Expected knowledge, skills and attitudes to be gained

The successful candidate will have opportunities to receive formal training in qualitative research methodology from the supervisory team and the school’s extensive short course program. The candidate will also develop specialist knowledge in surgical innovation and treatment decision-making. They will develop skill necessary for working in inter-disciplinary teams and effective dissemination of scientific outputs for a range of audiences.   

Academic background of the student

This project would suit individuals with a first or upper second-class honours undergraduate degree, preferably in a related discipline (these may include, but are not limited to: psychology, anthropology, sociology, or medicine). A relevant Master’s degree and experience of research would be desirable, but is not essential.  

References

  1. Elliott D, Blencowe NS, Cousins S, Zahra J, Skilton A, Mathews J, et al. Using qualitative research methods to understand how surgical procedures and devices are introduced into NHS hospitals: the Lotus study protocol. 2021;11(12):e049234.