Surgeons need to improve how they communicate with patients about innovative procedures
Press release issued: 14 August 2023
Patients are not given sufficient information about the novel status of a procedure, possible uncertainties or potential risks when deciding to go ahead with the procedure, research led by the University of Bristol and published in the Annals of Surgery has found.
The study, funded by the National Institute of Health and Care Research Bristol Biomedical Research Centre (NIHR Bristol BRC), is one of the first pieces of work to investigate these issues and examine exactly what patients are told about innovative surgical procedures.
Whilst surgical innovation is crucial to improving outcomes, an independent safety review led by Baroness Cumberlege highlighted that patients may not be getting all the information they need before undergoing new procedures. Current guidance says that patients need to be given enough information to fully consider the risks and benefits of a new procedure.
To investigate current practice, the study team looked at consultations between surgeons and patients in which new procedures were discussed. They focused on seven different procedures that were being introduced in five NHS hospitals. Nine clinicians carrying out innovative procedures were also interviewed about what they wanted to tell patients.
Researchers found that clinicians fully intended to discuss the innovative nature of the procedures but admitted these conversations could be difficult. The team audio-recorded 37 consultations between clinicians and patients during which innovative procedures were discussed.
The recordings revealed only a minority of clinicians talked explicitly about the procedure being innovative, their limited experience with it, the lack of evidence and uncertainty of what the outcome would be. The study also showed that all the clinicians were optimistic about the benefits of a new type of procedure, but often did not discuss the potential risks associated with it.
Thirty post-operative interviews were then conducted with patients. Researchers did this to understand what patients thought about the information they had been given.
Patients reported having a strong sense of trust in their clinicians and described feeling reassured by their confident attitude. They also picked up on the enthusiasm of clinicians towards procedures that they considered 'the future'. Many thought the procedures were more established than they actually were and felt that they were not told about potential disadvantages of undergoing the new procedure.
Dr Daisy Elliott, lead author and Research Fellow in the Bristol Medical School: Population Health Sciences (PHS), said: "This study provides important insights into the communication process surrounding innovative surgical procedures and devices. Despite the clinicians’ best intentions, many patients weren’t fully informed about innovative procedures. Whilst there is often a belief that ‘new is better’, this research highlights that clinicians can find it difficult to provide neutral and balanced information in this context. A major focus of our work at the Bristol BRC will be to work with clinicians to provide support and training, so that patients can make well informed decisions about undergoing new procedures."
Paula Goss, founder of Rectopexy mesh victims and support and ambassador for Mesh UK, added: "Fully informed consent discussions are crucial for patient safety for all procedures. Consultants and nurses should speak to patients thoroughly and transparently, allow recording of the consultations for patients to think about the information provided, and patients should be able to continue a dialogue to ask any question before any procedure. This should be a mandatory requirement for all hospitals and healthcare settings. Thorough in-depth patient involvement at every stage is the only way to provide and correct the issue of lack of trust that arises commonly with patients about to undergo any procedure."
Jane Blazeby, Professor of Surgery in the Bristol Medical School: (PHS) and project lead, said: "To our knowledge this is the first time that conversations between clinicians and patients discussing innovative surgical procedures have been investigated. It highlights the need for a standard approach that provides clear and unbiased information for patients. This is our next plan to improve this process to benefit patients, surgeons and the NHS."
'What are patients told about innovative surgical procedures? A qualitative synthesis of seven case studies in the UK‘ by Daisy Elliott, Jane M Blazeby et al. in Annals of Surgery [open access]
About the National Institute for Health and Care Research
The mission of the National Institute for Health and Care Research (NIHR) is to improve the health and wealth of the nation through research. We do this by:
- Funding high quality, timely research that benefits the NHS, public health and social care;
- Investing in world-class expertise, facilities and a skilled delivery workforce to translate discoveries into improved treatments and services;
- Partnering with patients, service users, carers and communities, improving the relevance, quality and impact of our research;
- Attracting, training and supporting the best researchers to tackle complex health and social care challenges;
- Collaborating with other public funders, charities and industry to help shape a cohesive and globally competitive research system;
- Funding applied global health research and training to meet the needs of the poorest people in low and middle income countries.
NIHR is funded by the Department of Health and Social Care. Its work in low- and middle-income countries is principally funded through UK Aid from the UK government.
About NIHR Bristol Biomedical Research Centre
NIHR Bristol Biomedical Research Centre’s (Bristol BRC) innovative biomedical research takes science from the laboratory bench or computer and develops it into new drugs, treatments and health advice. It focuses on early phase translational research and experimental medicine that aims to improve mental and respiratory health, optimise physical activity, nutrition and weight maintenance in the population, and introduce new surgical and orthopaedic interventions safely and ethically.
Bristol BRC draws on Bristol’s expertise in developing interventions to improve the health of patients and the public. Its world-leading scientists use detailed genetic and molecular data to understand causes of disease. They also evaluate new surgical procedures and analyse large-scale datasets from records collected during routine NHS care. Bristol BRC is unique among the NIHR’s 20 BRCs across England, thanks to its expertise in ground-breaking population health research.