OSIRIS: Better decision making for high-risk surgical patients

The OSIRIS programme is a major piece of research which aims to understand and improve the shared decision making process for patients at high risk of medical complications as they contemplate major surgery.

Bowel & Cancer Research is delighted to be collaborating with Queen Mary University on this exciting and important study, through involving patients in all key aspects of the design and delivery of the research.

Decision making for high risk surgical patients

Each year in the NHS, 250,000 high-risk patients undergo major surgery. This group typically consists of older patients with chronic disease, who often experience serious medical complications after surgery, such as pneumonia or heart attacks.

These complications can occur even when surgery and anaesthesia have been uneventful, and lead directly to poor long-term outcomes and quality of life. We know older patients with long-term disease have different hopes and expectations of healthcare, and need different information when choosing high burden treatments.

Through establishing effective ways that clinical teams and patients and their families communicate around decisions relating to major surgery and the outcomes that they can expect to achieve, the OSIRIS team hopes to give more control within the process to patients and their families.

Why is a study into decision making for high risk patients needed?

Often decision making on major surgery for high risk groups, when the decision is more about quality of life and less about survival, is fraught with other factors which can affect long term outcomes, but which are difficult to consider and often poorly understood.

Better understanding the values and beliefs of these patients is potentially critical to successful living after surgery. The OSIRIS study will create a supported pathway to aid consultation between patients and their clinicians so that final decisions related to surgery best reflect the long term needs, wants and values of the patient and their families, and the implications that the surgical intervention may have on these.

How will the study into decision making in high risk surgery be conducted?

Throughout the study the team will explore three contrasting patient scenarios where surgery is the main option: severe osteoarthritis, bowel cancer, and severe heart disease.

Initial studies will involve interviews and surveys with patients and doctors. A research analyst will analyse the data within large NHS databases to provide accurate data on patient outcomes, and integrate this with other published and unpublished information to bring the evidence together.

Finally the team will co-design with patients a decision aid, to integrate individual patient’s views about the important outcomes after surgery with accurate data predicting their most likely outcome. They will then test this decision aid in a randomised trial of 300 patients to confirm the benefit and acceptability of this technology to patients and doctors.

Patient and public involvement in the study into decision making in high risk surgery

Bowel & Cancer Research will ensure that patients will be involved throughout this research from development, through co-design of the decision aid, to dissemination.