Protocol paper for SMART OPS: Shared decision-making Multidisciplinary Approach – a Randomised controlled Trial in the Older adult Population considering Surgery
Introduction The Australian population presenting with surgical pathology is becoming older, frailer and more comorbid. Shared decision-making is rapidly becoming the gold standard of care for patients considering high-risk surgery to ensure that appropriate, value-based healthcare decisions are mad...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2023-07-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/13/7/e070159.full |
| _version_ | 1797745447285030912 |
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| author | Daniel Barker John Attia Simon Deeming Paul Healey Steve Smith Natalie Lott Angela Baker Pragya Ajitsaria Jeanette Lacey Monique Magnusson Jeanene Lizbeth Douglas Eileen Tan-Gore Stuart V Szwec Meredith Tavener Jon Gani |
| author_facet | Daniel Barker John Attia Simon Deeming Paul Healey Steve Smith Natalie Lott Angela Baker Pragya Ajitsaria Jeanette Lacey Monique Magnusson Jeanene Lizbeth Douglas Eileen Tan-Gore Stuart V Szwec Meredith Tavener Jon Gani |
| author_sort | Daniel Barker |
| collection | DOAJ |
| description | Introduction The Australian population presenting with surgical pathology is becoming older, frailer and more comorbid. Shared decision-making is rapidly becoming the gold standard of care for patients considering high-risk surgery to ensure that appropriate, value-based healthcare decisions are made. Positive benefits around patient perception of decision-making in the immediacy of the decision are described in the literature. However, short-term and long-term holistic patient-centred outcomes and cost implications for the health service require further examination to better understand the full impact of shared decision-making in this population.Methods We propose a novel multidisciplinary shared decision-making model of care in the perioperative period for patients considering high-risk surgery in the fields of general, vascular and head and neck surgery. We assess it in a two arm prospective randomised controlled trial. Patients are randomised to either ‘standard’ perioperative care, or to a multidisciplinary (surgeon, anaesthetist and end-of-life care nurse practitioner or social worker) shared decision-making consultation. The primary outcome is decisional conflict prior to any surgical procedure occurring. Secondary outcomes include the patient’s treatment choice, how decisional conflict changes longitudinally over the subsequent year, patient-centred outcomes including life impact and quality of life metrics, as well as morbidity and mortality. Additionally, we will report on healthcare resource use including subsequent admissions or representations to a healthcare facility up to 1 year.Ethics and dissemination This study has been approved by the Hunter New England Human Research Ethics Committee (2019/ETH13349). Study findings will be presented at local and national conferences and within scientific research journals.Trial registration number ACTRN12619001543178. |
| first_indexed | 2024-03-12T15:23:24Z |
| format | Article |
| id | doaj.art-08854bfaece94bbabe37e62a0b3cbaa9 |
| institution | Directory Open Access Journal |
| issn | 2044-6055 |
| language | English |
| last_indexed | 2024-03-12T15:23:24Z |
| publishDate | 2023-07-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj.art-08854bfaece94bbabe37e62a0b3cbaa92023-08-10T16:20:07ZengBMJ Publishing GroupBMJ Open2044-60552023-07-0113710.1136/bmjopen-2022-070159Protocol paper for SMART OPS: Shared decision-making Multidisciplinary Approach – a Randomised controlled Trial in the Older adult Population considering SurgeryDaniel Barker0John Attia1Simon Deeming2Paul Healey3Steve Smith4Natalie Lott5Angela Baker6Pragya Ajitsaria7Jeanette Lacey8Monique Magnusson9Jeanene Lizbeth Douglas10Eileen Tan-Gore11Stuart V Szwec12Meredith Tavener13Jon Gani143 Hunter Medical Research Institute, Newcastle, New South Wales, Australia2 School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia6 Health Research Economics, Hunter Medical Research Institute, Newcastle, New South Wales, Australia1 Department of Anaesthesia, John Hunter Hospital, Newcastle, New South Wales, Australia2 School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia2 School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia2 School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia1 Department of Anaesthesia, John Hunter Hospital, Newcastle, New South Wales, Australia2 School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia1 Department of Anaesthesia, John Hunter Hospital, Newcastle, New South Wales, Australia1 Department of Anaesthesia, John Hunter Hospital, Newcastle, New South Wales, Australia4 Department of Surgery, John Hunter Hospital, Newcastle, New South Wales, Australia3 Hunter Medical Research Institute, Newcastle, New South Wales, Australia2 School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia2 School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, AustraliaIntroduction The Australian population presenting with surgical pathology is becoming older, frailer and more comorbid. Shared decision-making is rapidly becoming the gold standard of care for patients considering high-risk surgery to ensure that appropriate, value-based healthcare decisions are made. Positive benefits around patient perception of decision-making in the immediacy of the decision are described in the literature. However, short-term and long-term holistic patient-centred outcomes and cost implications for the health service require further examination to better understand the full impact of shared decision-making in this population.Methods We propose a novel multidisciplinary shared decision-making model of care in the perioperative period for patients considering high-risk surgery in the fields of general, vascular and head and neck surgery. We assess it in a two arm prospective randomised controlled trial. Patients are randomised to either ‘standard’ perioperative care, or to a multidisciplinary (surgeon, anaesthetist and end-of-life care nurse practitioner or social worker) shared decision-making consultation. The primary outcome is decisional conflict prior to any surgical procedure occurring. Secondary outcomes include the patient’s treatment choice, how decisional conflict changes longitudinally over the subsequent year, patient-centred outcomes including life impact and quality of life metrics, as well as morbidity and mortality. Additionally, we will report on healthcare resource use including subsequent admissions or representations to a healthcare facility up to 1 year.Ethics and dissemination This study has been approved by the Hunter New England Human Research Ethics Committee (2019/ETH13349). Study findings will be presented at local and national conferences and within scientific research journals.Trial registration number ACTRN12619001543178.https://bmjopen.bmj.com/content/13/7/e070159.full |
| spellingShingle | Daniel Barker John Attia Simon Deeming Paul Healey Steve Smith Natalie Lott Angela Baker Pragya Ajitsaria Jeanette Lacey Monique Magnusson Jeanene Lizbeth Douglas Eileen Tan-Gore Stuart V Szwec Meredith Tavener Jon Gani Protocol paper for SMART OPS: Shared decision-making Multidisciplinary Approach – a Randomised controlled Trial in the Older adult Population considering Surgery BMJ Open |
| title | Protocol paper for SMART OPS: Shared decision-making Multidisciplinary Approach – a Randomised controlled Trial in the Older adult Population considering Surgery |
| title_full | Protocol paper for SMART OPS: Shared decision-making Multidisciplinary Approach – a Randomised controlled Trial in the Older adult Population considering Surgery |
| title_fullStr | Protocol paper for SMART OPS: Shared decision-making Multidisciplinary Approach – a Randomised controlled Trial in the Older adult Population considering Surgery |
| title_full_unstemmed | Protocol paper for SMART OPS: Shared decision-making Multidisciplinary Approach – a Randomised controlled Trial in the Older adult Population considering Surgery |
| title_short | Protocol paper for SMART OPS: Shared decision-making Multidisciplinary Approach – a Randomised controlled Trial in the Older adult Population considering Surgery |
| title_sort | protocol paper for smart ops shared decision making multidisciplinary approach a randomised controlled trial in the older adult population considering surgery |
| url | https://bmjopen.bmj.com/content/13/7/e070159.full |
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