A cluster-randomised controlled trial to establish the impact of a tailored surgical decision-making intervention

on quality of life outcomes in patients with incurable cancer in the final year of life

Summary

The final year of life can be a challenging and sensitive time for patients and their families. It often requires complex decision-making about undergoing treatments, typically in the context of uncertainty and limited or absent information (evidence) to guide decisions.

Decisions about surgical/invasive procedures can be especially challenging: unlike drug regimens that can be stopped/modified, undergoing a surgical/invasive procedure typically cannot be undone. These procedures are typically offered with the aim of improving symptoms and increasing the likelihood that patients will be able to perform activities important to them, but the opposite can also be true: all surgical/invasive procedures have risks and disadvantages, which can have important implications for the final year of life. It is therefore critical that decisions about undergoing surgical/invasive procedures are made based on clear/accurate information and consideration of what is important to patients/their families in the final year of life.

Although the above standards are widely endorsed, they can be difficult to achieve in practice. Accumulating research from the UK and internationally point to the same conclusion: there is a need to improve how healthcare professionals communicate about surgical/invasive procedures at the end of life. Healthcare professionals themselves also report a desire for more training in this area. We are proposing a study across hospitals in the UK to determine whether a new approach to communicating about treatments will lead to improved quality of life, in patients diagnosed with cancer who are considering undergoing a surgical/invasive procedure in the final year of life.