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Are trainees working in obstetrics and gynecology confident and competent in the care of frail gynecological oncology patients?
  1. Gemma Louise Owens1,2,
  2. Vanitha Sivalingam1,
  3. Mohamed Abdelrahman3,
  4. James P Beirne4,5,
  5. Dominic Blake6,
  6. Anna Collins7,
  7. Rhianna Davies8,
  8. James Dilley9,
  9. Malcolm Farquharson10,
  10. Diana Frimpong11,
  11. Nana Gomes12,
  12. Sarah Hawco13,
  13. Narthana Ilenkovan14,
  14. Eleanor Jones1,
  15. Sadie Esme Fleur Jones15,
  16. Tabassum Khan16,
  17. Elaine Leung17,
  18. Mohamed Otify18,
  19. Laura Parnell19,
  20. Michael P Rimmer20,
  21. Neil Ryan21,
  22. Peter Sanderson22,23,
  23. Linden Stocker24,
  24. Michael Wilkinson25,
  25. Siewchee Wong26,
  26. Rasiah Bharathan27 and
  27. Yee-Loi Louise Wan1
  28. The Audit and Research in Gynaecological Oncology (ARGO) Collaborative
  1. 1Division of Cancer Sciences, School of Medicine, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
  2. 2Obstetrics and Gynaecology, Sharoe Green Unit, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
  3. 3Obstetrics and Gynaecology, Stepping Hill Hospital, Stockport, UK
  4. 4Patrick J Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
  5. 5Northern Ireland Gynaecological Cancer Centre, Belfast Health and Social Care Trust, Belfast, UK
  6. 6Northern Gynaecological Oncology Centre, Queen Elizabeth Hospital, Gateshead Health NHS Foundation Trust, Gateshead, UK
  7. 7Leicester Cancer Research Centre, University of Leicester, Leicester, UK
  8. 8Obstetrics and Gynaecology, Addenbrooke's Hospital, Cambridge, UK
  9. 9Gynaecological Oncology, Barts and The London NHS Trust, London, UK
  10. 10Obstetrics and Gynaecology, Glasgow Royal Infirmary, Glasgow, UK
  11. 11East Gynaecological Oncology Centre, Queen Elizabeth the Queen Mother Hospital, Margate, UK
  12. 12Gynaecological Oncology, St George's Hospital, London, UK
  13. 13Obstetrics and Gynaecology, Ninewells Hospital, Dundee, UK
  14. 14Obstetrics and Gynaecology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
  15. 15Department of Cancer and Genetics, School of Medicine, Cardiff University, Cardiff, UK
  16. 16Gynaecological Oncology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
  17. 17Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
  18. 18Gynaecological Oncology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
  19. 19Obstetrics and Gynaecology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
  20. 20MRC Centre for Reproductive Health, Queens Medical Research Institute, University of Edinburgh, Edinburgh, UK
  21. 21Academic Centre for Women's Health, University of Bristol, Bristol, UK
  22. 22Gynaecological Oncology, Simpson Centre for Reproductive Health, Edinburgh, UK
  23. 23Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
  24. 24Academic Unit of Human Development and Health, University of Southampton, Southampton, UK
  25. 25Gynaecological Oncology, Mater Misericordiae University Hospital, Dublin, Ireland
  26. 26Obstetrics and Gynaecology, Lincoln County Hospital, Lincoln, UK
  27. 27Gynaecological Oncology, University Hospitals of Leicester NHS Trust, Leicester, UK
  1. Correspondence to Dr Gemma Louise Owens, Division of Cancer Sciences, School of Medicine, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9WL, UK; gemma.owens{at}manchester.ac.uk

Abstract

Introduction Older patients undergoing cancer surgery are at increased risk of post-operative complications, prolonged hospital stay, and mortality. Identification of frailty can help predict patients at high risk of peri-operative complications and allow a collaborative, multidisciplinary team approach to their care. A survey was conducted to assess the confidence and knowledge of trainees in obstetrics and gynecology regarding identification and management of peri-operative issues encountered in frail gynecological oncology patients.

Methods A web-based survey was distributed via the Audit and Research in Gynaecological Oncology (ARGO) collaborative and UK Audit and Research Collaborative in Obstetrics and Gynaecology (UKARCOG) . The survey on the management of frail peri-operative patients was disseminated to doctors-in-training (trainees) working in obstetrics and gynecology in the United Kingdom (UK) and Ireland. Specialty (ST1–7), subspecialty, and general practice trainees, non-training grade doctors, and foundation year doctors currently working in obstetrics and gynecology were eligible. Consultants were excluded. Study data were collected using REDCAP software hosted at the University of Manchester. Responses were collected over a 6-week period between January and February 2020.

Results Of the 666 trainees who participated, 67% (425/666) reported inadequate training in peri-operative management of frail patients. Validated frailty assessment tools were used by only 9% (59/638) of trainees and less than 1% (4/613) were able to correctly identify all the diagnostic features of frailty. Common misconceptions included the use of chronological age and gender in frailty assessments. The majority of trainees (76.5%, 448/586) correctly answered a series of questions relating to mental capacity; however, only 6% (36/606) were able to correctly identify all three diagnostic features of delirium. A total of 87% (495/571) of trainees supported closer collaboration with geriatricians and a multidisciplinary approach.

Conclusions Obstetrics and gynecology trainees reported inadequate training in the peri-operative care of frail gynecological oncology patients, and overwhelmingly favored input from geriatricians. Routine use of validated frailty assessment tools may aid diagnosis of frailty in the peri-operative setting. There is an unmet need for formal education in the management of frail surgical patients within the UK and Irish obstetrics and gynecology curriculum.

  • postoperative care
  • surgical oncology
  • gynecology
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Footnotes

  • Twitter @jamesybeirne, @drsadiejones, @RasiahBharathan

  • Collaborators All authors are part of the Audit and Research in Gynaecological Oncology (ARGO) Collaborative.

  • Contributors RB, GLO, VS, Y-LLW: designed and implemented the study, interpreted the data, drafted and revised the final manuscript. MA, JPB, DB, AC, RD, JD, MF, DF, NG, SH, NI, EJ, SEFJ, TK, EL, MO, LP, MPR, NR, PS, LS, MW, SW: acquired data via participant recruitment, revised and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request to gemma.owens@manchester.ac.uk.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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