Quality of surgery in oncological trials: the patient's perspective

Background

There has recently been increased focus on patient involvement in decision making within healthcare research. Although expert opinion regarding quality of surgery in oncological trials has been reported, the patients’ perspective has not yet been explored.

Methods

Two in-depth focus groups were conducted with ten participants representing the oesophageal patient association (OPA). Focus group discussion explored patients’ opinion regarding quality of surgery in trials and potential mitigating strategies. Identified themes were utilised to create a semi-structured survey subsequently completed by 41 OPA members.

Results

Forty-five themes were identified from thematic analysis of focus group data falling within three categories: quality of surgery (n = 16); challenges to quality of surgery (n = 16) and proposed mitigating strategies (n = 13). Strategies to overcome generic challenges included: further education for non-specialists, and enhancing surgeons' training. Trial specific mitigating strategies included: utilising a structured method of assessing surgeons’ competencies, including specialist centres, and monitoring of surgery. The survey revealed key challenges to quality of surgery included insufficient beds (90 %) and a lack of funding (75 %). Key survey strategies to overcome challenges to quality of surgery included: Monitoring to check operative standards are being met within trials (94 %), and; raising awareness/training regarding postoperative complications amongst non-specialist healthcare providers (94 %).

Conclusion

This is the first study to explore patient perspective on quality of surgery. Public healthcare planners and members of the surgical oncology community should recognise the importance of patient perceived challenges and consider incorporation of their proposed mitigation strategies to improve the quality of surgery in clinical trials.