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Improving shared decision making for high risk gynaecology oncology surgery.

Using an invested team approach we aim to enable patient agency in their care by providing evidenced based information, supporting decision making process and optimising modifiable risk factors early.

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  • Proposal
  • 2020

Meet the team


  • Miss Nicola MacDonald - Consultant Gynaecological Oncologist
  • Dr Claire Frith-Keyes - Consultant Anaesthetist
  • Katrina Huges - General Manager
  • Georgina Bull - Matron

What is the positive change that has emerged through new collaborations or partnerships during Covid-19 that your project is going to embed?

During Covid-19 many gynaecology cancers have been diagnosed later and at UCLH we have recorded increased activity in high risk major surgical procedures.  Over these months many patients have been balancing risk on their own; weighing up seeking healthcare for troubling symptoms versus Covid-19 risk or opting to delay and decline surgery in fear of Covid-19 risks in hospitals.

Shared decision making is recognised as best practice by NICE and is used by surgeons in the consent process for surgery.  The enhanced muti-disciplinary team (MDT) collaboration experienced during the pandemic is something we want to instill in to every patient encounter.  Shared decision making for high risk surgery is a complex decision and just because the surgery can be done doesn’t mean that is should.  We aim to set up a joint specialist clinic with consultant surgeon, anaesthetist and Macmillan nurse to inform and support the patient’s decision.

What does your project aim to achieve?

  • Increase knowledge of patient medical history – gather more clinical patient information from referrer before 1st patient appointment.
  • High risk surgical patients will be seen by consultant surgeon, consultant anaesthetist and Macmillan nurse; all experienced in gynaecology oncology.
  • Every patients has time to discuss their personal preferences and understands their treatment options:
    • What are the benefits?
    • What are the risks ?
    • What are the alternatives?
    • What if I do nothing?
  • Patients will be screened using validated risk assessment tools 
  • Patients will understand their role – Digitally enabled education to reach patients in their own homes.  Expand use of UCLH electronic patient portal ‘MyCare’, virtual surgery school, video and podcast information with language subtitles and telephone/video follow up options with interpreter.
  • Seek and act on patient & staff feedback to develop service
  • Improve surgical flow – Prevent cancellations on day of surgery and unexpected critical care admissions, reduce postoperative complications therefore reducing length of stay.

How will the project be delivered?

  1. UCLH cancer MDT coordinators contact GP for full medical history and recent test results – All information uploaded to Electronic health record system (Epic).
  2. Gynaecology oncology MDT meeting will stratify patients as high risk by proposed surgical procedure or known co-morbidities.
  3. Patients attend Gynaecology oncology clinic – Clinical observations, BMI, ECG & risk screening (nutrition, frailty & activity status) completed by support staff prior to 1:1 appointments.
  4. 1st appointment of day with consultant surgeon then Macmillan nurse or consultant anaesthetist.
  5. Virtual group education session on preparation and recovery within 5 days of the Shared decision making clinic to allow time to digest the diagnosis and treatment options – feedback generated realtime on Zoom polls.
  6. Measuring postoperative complications for comparison the baseline.
  7. Qualitative interviews for patient and staff feedback.

How is your project going to share learning?

This project will report to the Perioperative medicine operational group at UCLH.  The aim is to develop the gynaecology oncology shared decision making clinic for high risk surgery the standard for preoperative care at UCLH and use as a blue print for other specialities.  The project is supported by 3 divisional managers; Critical Care, Women’s Health & Surgical specialities.  Colorectal surgery team have a similar patient cohort and are planning to be ‘fast followers’.  We believe that we can design a project blue print that will be relatable to our partners in the North Central London Cancer Alliance and will benefit patients earlier in their cancer pathways.

Nationally we want to engage with the Q community to learn and share in special interests groups.  Promoting out work at Preoperative medicine conferences and through publication.

How you can contribute

  • Patient education options that reduce health inequalities.
  • Share experiance in running virtual patient groups.
  • Effectively engaging patients in service co-designing.
  • Critical friends to challenge our thinking.
  • Ideas to increase reach of shared learning.

Plan timeline

21 Sep 2020 Virtual surgery school observation UHS Fit4Surgery
1 Oct 2020 Project group planning meeting
19 Oct 2020 Trial stakeholder engagement - aims
20 Oct 2020 Information video and podcasts - Lead RMcD
3 Nov 2020 4 week trial start date & 4 patients per week
15 Dec 2020 Project team meeting and trial data analysis
5 Jan 2021 Promoting proposal within Q community and seeking expert development advice.
3 Feb 2021 Data collection tool design and commence build - Lead CFK
2 Mar 2021 Audit day - presentation of trial results and SDM coaching session.
3 Mar 2021 Project team implementation planning and recruitment
28 Mar 2021 Commence filming for information videos


  1. Hi Ruth

    I work for AQuA and lead a team that support SDM as part of our Person Centred Care Programmes - if you would like a conversation, or for us to share any of our learning or resources, please do not hesitate to get in contact - we have been working in this area for nearly 10 years at AQuA and have worked with all sorts of teams etc.

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