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CONSIDER-19-CRC

Communicating Surgical Decision-Making during the COVID-19 pandemic: colorectal cancer

Chief Investigator

Institution

Dates

Funding Stream

Amount
Dr Leila Rooshenas

University Hospitals Bristol and Weston NHS Foundation Trust 

01/10/2020 to 30/09/2021

Above and Beyond Bowel Cancer Legacy 2020-21

£20,952.00

Summary

The COVID-19 (coronavirus) pandemic has changed how NHS care is delivered. The surge of critically unwell patients has led to many services being cancelled or postponed, including planned operations for bowel cancer. Usual approaches to treating bowel cancer have also needed to adapt for safety reasons, to reduce the risk of exposing patients to COVID-19. However, a short pause or change to normal bowel cancer services can also have potentially serious effects on patients' quality of life and survival.

While the peak of infections may have passed, resuming normal NHS services will take time. The NHS recommends a system to prioritise patients, to ensure those most in need receive their operation first, in as safe a way as possible. There will, however, be a backlog of patients awaiting surgery, and some may be offered non-surgical or palliative care.

Healthcare professionals need to clearly communicate information about delays and changes to bowel cancer treatment with patients. These conversations can be complex, but it is important they are delivered well, so that patients can make informed decisions and adhere with clinical recommendations. We will study these conversations, and ask healthcare professionals and patients about their views on changes to bowel cancer services and what may improve their experiences in the current climate. We will share our findings to improve how healthcare professionals communicate with patients about cancer treatment and the consequences of COVID-19. We will also use our findings to plan future research to improve cancer care during and after the pandemic.

Findings

The initial findings have implications for surgeons, hospital Trust managers, and policy makers managing surgical provision for future medical emergencies and in the recovery stages of the pandemic.

  1. Better support is needed for surgeons tasked with prioritising patients. COVID-19 pressures have arguably exposed more healthcare professionals to these contentious decisions, including those who may not have typically had to consider resource allocation in their day-to-day practices.
  2. Fuller consideration could be given to identifying and addressing the barriers and facilitators to drawing on independent sector provision in the event of restricted access to NHS surgical capacity.
  3. Bodies responsible for producing guidance should commit to streamlining the quantity of guidance produced, strive for the content to be digestible, unambiguous, and aligned and as far as possible, draw on up-to-date peer reviewed evidence.

Further implications are in development.

Outputs

Conferences - oral presentations

13th International Society for Priorities in Health Conference: Fair Priorities in Unjust Circumstances, 28 - 30 April 2022 Norway. Oral presentation: Prioritisation in the United Kingdom National Health Service during a national emergency: a qualitative case study of surgical teams' experiences of colorectal cancer surgery in the acute early stages of the Covid-19 pandemic.

HSR-UK Conference, 5-7 July 2022, Sheffield. Oral Presentation: Patient experiences of being diagnosed and treated for cancer the during the COVID-19 pandemic: A qualitative study of patients with colorectal cancer.

Publications

Managing demand for surgery when needs outstrip resources: a UK-based qualitative investigation of the challenges and solutions to colorectal cancer surgery provision in the first wave of the COVID-19 pandemic. Drafted for the BJS and currently being reviewed by the CONSIDER-19 study team for submission in March 2022.

A second paper is in preparation and will focus on the patient perspective of considering and receiving surgical care during the Covid-19 pandemic.

Opportunities for a related synthesis paper with colleagues involving multiple surgical specialisms is under consideration. 

Larger grants

Contributed to successful renewal of Bristol Biomedical Research Centre (BRC) ('communication' workstream within £3.6m Surgical Innovation theme).

Other project outcomes

This project has catalysed new collaborations with surgical teams in Imperial College London, Gloucester Royal Hospital, Wythenshawe Hospital and University Hospitals Leicester. 

The project has also fostered inter-disciplinary collaborations amongst researchers in the School of Physiological Sciences and Population Health Sciences. The findings arising from surgeon interviews have informed a project that aims to inform updated guidance around aerosol generating procedures in the recovery phases of the COVID-19 pandemic.

The findings from this project, particularly around the challenges of prioritisation are informing the work of a related NIHR funded project to evaluate NHS England's Evidence-Based Interventions (EBI) programme (NIHR130547).