The ALPACA study

High quality shared decision making processes that focus on the patient are an important part of modern healthcare systems.

Shared decision making is when patients and health professionals make treatment decisions together. It is particularly important for patients undergoing surgical procedures because, unlike many medical therapies, the effects of surgery are immediate and irreversible.

This means patients can’t stop treatment even if the benefits they experience fall short of what they expect or the side effects they develop become unacceptable.

Project aims

The overall aim of this project is to develop, pilot and evaluate an intervention that uses novel methods to get real-time feedback about patient experiences of shared decision making during surgery. We want to change how shared decision making is done to improve outcomes for both patients undergoing surgery and the health service.

Our work so far

So far, we have established how routine data is automatically collected in several hospitals. We have also investigated the feasibility and acceptability of monitoring shared decision making in real time with the help of an automated electronic patient reported outcome measurement. We did this during a study hosted by one of the NHS trusts in Bristol.

The aim of this study was to evaluate the effectiveness, efficiency and user satisfaction of an electronic measurement system we adapted to collect patient experiences of shared decision making in real-time. We collected quantitative data, between April and December 2021, from adult patients booked for urgent and elective surgery across seven specialties. Patients were asked to complete a brief survey with some subsequently being asked to take part in an interview.

Overall, users found our system easy to use and the survey quick to complete. Average completion time was three minutes. This suggested good system efficiency and effectiveness. The survey response rate was good and usability amongst patients was high. Findings from the interviews we conducted emphasized good user satisfaction.

However, service users also identified potential barriers to acceptability and ease of access. We are currently exploring how to improve these aspects of the intervention by conducting interviews with under-served groups (elderly, ethnic minority, economically disadvantaged). These groups are thought to experience barriers to accessing our system and are disproportionately affected by poor shared decision making.

We will use findings from this study, alongside further evaluation, to demonstrate the scalability of our system. Future pilot work will optimise the system for wider implementation to ultimately inform intervention development to improve shared decision making.

What we hope to achieve

Overall, we hope that our work will inform a future randomised controlled trial. The aim of this trial would be to evaluate the effectiveness and cost-effectiveness of real time pre-operative shared decision making monitoring with feedback by comparing it to monitoring alone.