Conectar
To explore the experiences and perceptions of people with advanced cancer and their family caregivers of shared decision-making, including how they and nurses are involved.
Exploratory interview study.
Semistructured, individual interviews conducted in 2023 were analysed using reflexive thematic analysis.
Twenty-four participants (15 people with cancer and 9 caregivers) participated in this study. The analysis generated five themes; (1) Decisions are ultimately about living or dying, (2) Desires and expectations for involvement in decision-making, (3) Uncertainty about potential and capacity for shared decision-making, (4) Good quality information and communication are key for involvement and (5) Nurses' contributions are unclear.
Overall, our participants were unsure about how decision-making about the complex and existential decisions in palliative cancer care was shared, or how it included them, or nurses.
People receiving care could benefit from more clarity on what shared decision-making is, how they can be involved and how nurses can facilitate and support shared decision-making.
Part of the nursing role is to support and involve people with cancer and family caregivers in decisions about treatment and care. Our findings suggest that people receiving care may be unclear about the concept of shared decision-making, and so also about how nurses potentially or actually support decision-making. Our study further clarifies the challenges and possibilities for involving all stakeholders in shared decision-making. This additional insight may help in future development and implementation of shared decision-making.
COREQ.
Adds to knowledge and understanding of the complexity of shared decision-making in palliative cancer care and how nurses can contribute to this and advancing a person-centred approach.
A patient and public involvement group participated in all phases of planning and conducting this study.
To compare outcome data of hemicolectomy patients before and after the establishment of a preoperative anaesthesia assessment clinic (PAC).
This observational study was conducted retrospectively through an electronic health record review covering periods before (2014–2017) and after (2017–2022) the PAC was established.
An acute care hospital in Norway.
A total of 612 patients undergoing elective open or laparoscopic hemicolectomy were included, of whom 338 (55.2%) had attended the PAC.
The primary outcome was the rate of cancellation of planned surgeries, and the secondary outcomes were length of hospital stay (LOS), unanticipated intraoperative anaesthesia-related events and the presence of documentation relevant to the planning of anaesthesia in the patient’s medical records preoperatively.
Compared with the after-PAC cohort, the before-PAC cohort was numerically more likely to have their planned surgery cancelled (OR=1.97, 95% CI (0.84 to 4.61); p=0.12). The before-PAC cohort also had a numerically lower rate of unanticipated intraoperative anaesthesia-related events (18.6%) than the after-PAC cohort (22.5%; p=0.240). However, neither of these differences was statistically significant. Median LOS was significantly shorter in the after-PAC cohort (4.79 days, IQR (3.80–6.12)) than in the before-PAC cohort (5.16 days (4.09–7.18); p=0.001). Moreover, the presence of documentation relevant to the planned anaesthesia in the medical records was significantly more common for after-PAC patients.
The establishment of the PAC reduced the rate of planned surgery cancellations but increased the rate of recorded intraoperative anaesthesia events. Patients who attended the PAC had a significantly shorter LOS and more anaesthesia-related information in their medical records.
FreshRSS 