Qualitative study of clinician and patient perspectives on the mode of anaesthesia for emergency surgery

Abstract

Background Although delivering a chosen mode of anaesthesia for certain emergency surgery procedures is potentially beneficial to patients, it is a complex intervention to evaluate. This qualitative study explored clinician and patient perspectives about mode of anaesthesia for emergency surgery. Methods Snowball sampling was used to recruit participants from eight National Health Service Trusts that cover the following three emergency surgery settings: ruptured abdominal aortic aneurysms, hip fractures and inguinal hernias. A qualitative researcher conducted interviews with clinicians and patients. Thematic analysis was applied to the interview transcripts. Results Interviews were conducted with 21 anaesthetists, 21 surgeons, 14 operating theatre staff and 23 patients. There were two main themes. The first, impact of mode of anaesthesia in emergency surgery, had four subthemes assessing clinician and patient ideas about: context and the ‘best’ mode of anaesthesia; balance in choosing it over others; change and developments in anaesthesia; and the importance of mode of anaesthesia in emergency surgery. The second, tensions in decision‐making about mode of anaesthesia, comprised four subthemes: clinical autonomy and guidelines in anaesthesia; conforming to norms in mode of anaesthesia; the relationship between expertise, preference and patient involvement; and team dynamics in emergency surgery. The results highlight several interlinking factors affecting decision‐making, including expertise, preference, habit, practicalities, norms and policies. Conclusion There is variation in practice in choosing the mode of anaesthesia for surgery, alongside debate as to whether anaesthetic autonomy is necessary or results in a lack of willingness to change.

Regional anaesthesia practice for arteriovenous fistula formation surgery

“…The range of factors identified as shaping choice of anaesthesia modality demonstrates the complexity of anaesthesia as an intervention and that the choice of mode of anaesthesia is determined by several interlinking factors that include not just the anaesthetist, but also the patient and surgeon. This concurs with a recently published qualitative study of clinician and patient perspectives on the mode of anaesthesia by Dooley et al., which also demonstrated that decisions about the mode of anaesthesia depend upon several interlinking factors, including expertise, preference, habit, practicalities and norms . This also showed variation in practice in choosing modes of anaesthesia and significant uncertainty regarding the effects of different anaesthesia types on post‐operative outcomes .…”

“…This concurs with a recently published qualitative study of clinician and patient perspectives on the mode of anaesthesia by Dooley et al., which also demonstrated that decisions about the mode of anaesthesia depend upon several interlinking factors, including expertise, preference, habit, practicalities and norms . This also showed variation in practice in choosing modes of anaesthesia and significant uncertainty regarding the effects of different anaesthesia types on post‐operative outcomes .…”

“…These should be explored and addressed in a future trial to support recruitment and informed decision making. A recent study from our group conducted detailed interviews with patients about mode of anaesthesia as an intervention and showed that patients are amenable to further prospective clinical research, particularly as an exploration of the effects of different modes of anaesthesia on patient outcomes after surgery may provide evidence‐based guidance for clinical decision making .…”

Protocol for a systematic review of reporting standards of anaesthetic interventions in randomised controlled trials

“…Clinician autonomy is acknowledged as a necessity in anaesthesia and is a fundamental reason for variation in practice. There is emerging evidence that the choice of mode of anaesthesia (GA, local anaesthesia, regional or sedation) is multifactorial, formulated around clinicians’ expertise, preference, habit, policies, practicalities and may also be influenced by other healthcare professionals and patients 4. While the autonomous nature of anaesthesia is partly unavoidable, the lack of standardisation and consistency in how anaesthetic techniques are defined, administered and reported complicates the interpretation of published evidence and planning of future RCTs 1 5…”

This month on Twitter

“…On 23 January, @bjsurgery held a joint tweetchat with @Anaes_Journal and the co‐authors of four papers on emergency surgery in the joint special issue. This generated over 8 million impressions for the tweetchat hashtag #BJSConnect, an increase from the previous BJS tweetchat impression count of 5 million.…”