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Understanding decision making about high risk surgery: a qualitative study of shared decision making by patients and their clinical teams


This study aims to understand how patients, their families and clinical teams approach and negotiate shared decision making for major surgery, and how they reflect on the decisions they make.


Around 1.5 million major surgical procedures are now performed each year in the UK with 250,000 at high risk of post-operative complications. Even when surgery and anaesthesia are straightforward, one in three high-risk patients develops medical complications which can delay recovery, prolong hospital stays and lead to a decline in functional independence once patients return home. Critically, many high-risk patients never recover from these adverse effects, suffering significant reductions in long-term quality of life and survival. For many, surgery is not the successful treatment they hoped for, with feelings of guilt or regret over the decision to undergo surgery commonplace. Doctors recognise the need to help improve decision making for this patient group but often feel ill-equipped to do so.

This first study in the OSIRIS programme aims to identify the key influences on the shared decision making process in three clinical areas - major joint, intra-abdominal and cardiac surgery - and to feed into subsequent studies in the wider programme which will develop and test an intervention aimed at improving decision-making processes.


We will use qualitative methods to explore in-depth how patients, their families and clinicians negotiate decision making and reflect back on the decisions they made. To do this we will do a combination of:

  1. Video-recording of decision making encounters for major surgery
  2. Individual and focus group interviews with patients, their carers/families and clinicians.

Funding: The study is funded via an NIHR Programme Grant for Applied Research, OSIRIS

This is led by Professor Rupert Pearse at Queen Mary, University of London