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147:oral Prioritisation in the United Kingdon national health service during a national emergency: a qualitative case study of surgical teams’ experiences of colorectal cancer surgery in the acute early stages of the COVID-19 pandemic
  1. Carmel Conefrey1,
  2. Leila Rooshenas1,
  3. Barry Main1,
  4. Kerry Avery1,
  5. Jo Bennett2,
  6. Jane Blazeby3,
  7. Natalie Blencowe4,
  8. Daisy Elliott1,
  9. Cynthia Ochieng1,
  10. Christin Hoffman1,
  11. Marcus Jepson5,
  12. James Kinross6,
  13. Angus McNair1,
  14. David Messenger7,
  15. Sarah Squire8,
  16. Anne Pullybank9,
  17. Sarah Duff10,
  18. Baljit Singh11
  1. 1Anni Skilton
  2. 1Bristol Medical School; University of Bristol; UK
  3. 2Gloucestershire Royal Hospitals NHS Foundation Trust
  4. 3University of Bristol and UHBW NHS Foundation Trust
  5. 4University of Bristol and UHBW Foundation Trust
  6. 5Bristol Medical School, University of Bristol
  7. 6Imperial College London
  8. 7University Hospitals Bristol and Weston NHS Foundation Trust
  9. 8Patient representative for this project, and member of the Association of Coloproctology of Great Britain and Ireland Patient Liaison Group, and PPI member on the NHS Specialised Colorectal Clinical Reference Group
  10. 9North Bristol NHS Trust
  11. 10Manchester University NHS Foundation Trust
  12. 11University Hospitals Leicester


Introduction The onset of the COVID-19 pandemic in early 2020 triggered reorganisation of hospital departments around the world as resources were configured to prioritise critical care. In spring 2020, NHS England issued national guidance proposing acceptable time intervals for postponing different types of surgical procedures for patients with cancer and other conditions. The ‘Consider-19’ study sought to investigate prioritisation decisions in practice, with in-depth examination of colorectal cancer surgery as a case-study, given recommendations that these procedures could be delayed by up to 12 weeks.

Methods Twenty-seven semi-structured interviews were conducted with healthcare professionals between June – November 2020. A key informant sampling approach was used, followed by snowballing to achieve maximum regional variation across the UK. Data were analysed thematically using the constant comparison approach.

Results Interviewees reported a spectrum of perceived disruption to colorectal cancer surgery services in the early phase of the pandemic, with some services reporting greater scarcity of resources than others. Nonetheless, all reported a need to prioritise patients based on local judgments. Prioritisation was framed by many as unfamiliar territory, requiring significant deliberation and emotional effort. Whilst national guidance provided a framework for prioritising, it was largely left to local teams to devise processes for prioritising within surgical specialities and then between different specialities, resulting in much local variation in practice.

Discussion The pandemic necessitated a significant change in practice as surgeons, in a tense and uncertain situation, found themselves having to navigate clinically, emotionally, and ethically-charged decisions about how best to use limited surgical resources. Whilst unavoidable, many felt uncomfortable with the task and the consequences for their patients. The findings point to a need to better support surgeons tasked with prioritising patients and raise questions about who should be involved in this activity.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: .

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