Shared decision making prior to emergency laparotomy: the perspectives of healthcare professionals, patients and their family

Background

Emergency laparotomy (EL) is associated with significant patient morbidity and mortality, with potential subsequent reduction in post-operative quality of life and loss of independence. The decision to undergo an EL is therefore important. This project aimed to understand stakeholder perceptions of the decision making process in the context of EL.

Methods
Semi structured qualitative interviews were undertaken with relevant healthcare professionals, patients who had undergone an EL and family members involved in the decision making process prior to an EL. Interviews took place online or over the phone. These interviews were audio-recorded and transcribed. Transcriptions underwent thematic analysis utilising principles of grounded theory. Dual-analysis was undertaken on 10% of transcripts.

Results

Twenty-one interviews with different stakeholders were completed. Six patients, one family member and fourteen healthcare professionals took part in the study. Healthcare professional speciality included surgeons, geriatricians, intensive care physicians, anaesthetists and advanced nurse practitioners.

Healthcare professional identified the unique context of emergency surgery impacting decision making, the presence of variation in both decision making practice and patient involvement in the decision making process and that different factors influence the decision to undergo EL.

Patients had poor recollection but identified variation in patient involvement in the decision-making process. They felt information delivery is key to patient involvement but recognized patient emotions impact decision making ability.

Discussion

Semi-structured interviews with different stakeholders have identified different themes that influence decision making prior to an emergency laparotomy. Further interviews are now required to explore these specific themes.