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Title: Information and informed consent in oesophagogastric cancer surgery
Author: McNair, Angus Gregor Keith
Awarding Body: University of Bristol
Current Institution: University of Bristol
Date of Award: 2011
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Oesophagogastric cancer represents a major healthcare burden in the UK. Surgery is the mainstay of treatment and often represents the only chance of long-term survival. However, treatment is associated with major morbidity and mortality and a potentially irreversible deterioration in quality of life. Authorising surgery is therefore an enormous decision for patients to make, often when anxious and unwell. The aim of this thesis was to explore the provision of, and need for, information before oesophagogastric cancer surgery. A validated questionnaire surveyed patients' views of information importance, including questions about the cancer and prognosis, tests, treatments, and impact on physical and psychosocial health. Audio-recorded out-patient consultations, followed by semi-structured interviews, supplemented questionnaire data and explored information provision and patients' information preferences using thematic analysis. Patients' understanding of visual information was assessed through interviews in which patients were asked to interpret series of graphs depicting hypothetical multidimensional quality of life data. A total of 136 of 226 (60.2%) invited patients completed the questionnaire. Patients rated most information highly but, in particular, potentially sensitive information (such as survival), complex information (such as the rationale behind treatment recommendations) and quality of life. 18 (17 male) patients underwent audio-recorded consultations and interviews. Consultations were found to involve uniform, methodical, surgeon-centric discussions of the process of surgery and short-term outcomes, and inconsistent, typically patient led discussions of quality of life issues. Interviews highlighted patients' desire for information about treatment eligibility, the process of surgery itself, survival and quality of life. 132 of 194 (68%) invited patients were interviewed to assess understanding of visual information. The majority understood simple (87%) and complex (81 %) multidimensional data. Recommended. information exchange between surgeons and patients selected for oesophagogastric cancer surgery includes communication of sensitive and complex concepts as well as information regarding the process of surgery. This research will inform the development of an intervention to improve information provision before cancer surgery.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available