Decision making in surgery and cancer care

Srinivasaiah, Narasimhaiah

July 2011

Thesis or dissertation

© 2011 Narasimhaiah Srinivasaiah. All rights reserved. No part of this publication may be reproduced without the written permission of the copyright holder.

Decision making in surgery and cancer care is an interesting, challenging, and yet little explored area of surgical sciences research. This research addresses that paucity. In performing this research, health outcomes research (HOR) literature was comprehensively reviewed. Health outcome measures including quality of life and health-related quality of Life were described, in addition to their measurements. Subsequently health outcome measures in relation to oncoplastic and aesthetic breast surgery were described, and health outcome measures in a number of benign breast and colorectal pathologies were studied.

Decision making in surgery and cancer care was explored using a mixed methodology of quantitative and qualitative studies. To derive a more comprehensive view, different specialties were explored: breast, colorectal, and head and neck surgery. To address socio-cultural factors the qualitative focus group discussions were undertaken in England, Wales, and India. Quantitative studies included literature reviews, prospective studies, retrospective studies, and questionnaire surveys. Qualitative studies were based on focus group discussions.

The results showed that raw quantitative data is only one of the factors influencing the decision making process. A number of other factors play an important role in the decision making process. These include: health outcome measures (quality of life, health-related quality of life), clinician factors (knowledge, skill, expertise, judgment), patient factors (socio-economic, education, cultural), nursing factors, translational research, and resource infrastructure.

Important themes and outcomes emerged from the qualitative studies. The focus group discussions showed that decision making in surgery and cancer care varies not only between the developing and the developed world, but also within different regions in the western world. In England, a small minority of patients was driving the decision making process, compared with Wales, where joint decision making is the norm. However, in India decision making is predominantly led by the clinicians and the patient’s family members. As modern health care moves towards a patient centered care approach, evidence based patient choice and patient decision making clearly has a greater role to play, and the cultural and practical issues demonstrated in this thesis must be considered.

Postgraduate Medical Institute, The University of Hull
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