Decision Report 202005707

Summary

C complained about the care and treatment that their spouse (A) received from the board. A was diagnosed with colorectal cancer (bowel cancer) and underwent colon cancer surgery abroad, before returning to the UK. They were reviewed by the board’s oncology team (cancer specialist team) and it was determined that the cancer had spread and that chemotherapy was required.

Although A initially responded well to chemotherapy, once the chemotherapy course ended, the cancer was found to have spread further. A was not considered fit enough to undergo further chemotherapy and died.

C complained to the board that, following the positive indications, the board failed to communicate clearly with A and their family about their prognosis, treatment and next steps. C raised particular concerns that clinicians were unwilling to give information about the nature and extent of A’s deterioration, the sizes of tumours identified and information about the treatment that could be provided.

C considered that the board failed to provide A with appropriate treatment during their time in hospital and that these failures could have resulted in A not being able to recover sufficiently to undergo further chemotherapy. C was concerned that A suffered a series of issues related to their stoma site (opening in the body) and C complained that these issues were not treated with sufficient urgency or concern.

In response to the complaint, the board provided a detailed account of the care provided to A and their communication with A's family. The board acknowledged that A responded well to chemotherapy but once the first six cycles were complete, the cancer started to grow aggressively and A never regained the fitness required to restart treatment. The board explained that following further review of A, it was established that surgery was not an option for A and gave their view as regards the progression of A's illness and recurrent infections which necessitated admittance to hospital. Additionally, the board clarified their understanding with respect to the communication with A and their family and explained why they considered this to be reasonable in the circumstances.

We took independent advice from a senior clinical oncologist. We found that the assessment and treatment of A’s cancer during the period concerned was reasonable. We considered a period of care during which A experienced difficulties with respect to their stoma site and infections and considered the care provided to be reasonable in the circumstances. We found that whilst there were clearly difficulties with respect to communication between clinicians and the family, medical professionals tried to answer questions about A’s care and there was evidence of appropriate communication with the family.

With respect to the care and treatment provided to A, we found that an appropriate diagnosis was made, with a reasonable treatment plan and follow up testing to monitor the effectiveness of treatment. Despite initial good progress, A's cancer progressed and decisions made about A's treatment, including that A was not fit for surgery, were clear with demonstrable reasoning. A suffered difficulties with infections and complications which, again, were appropriately responded to and treated. Overall, the care and treatment provided to A was reasonable and in line with good practice. As such, we did not uphold the complaint.

With respect to communication with A and their family, the records demonstrated that A and their family asked a lot of questions to help their understanding. There was evidence of frustration on both sides regarding the level and extent of communication and information requested. There may have been opportunity for clinicians to consider and better manage the family’s expectations about the level of detail which could be provided about the treatment and prognosis. However, we found that the level of detail about A’s care and treatment was in line with what would reasonably be expected in the circumstances and we did not uphold this complaint.