Recurring concern
Failure to discuss patient care options and decisions
- Reports that mention this concern
- 8
- Times this concern has been raised
- 8
- Stated actions linked to this concern
- 12
What this concern includes
Includes failures to discuss consequential patient-care options, decisions, expected outcomes or treatment rationale with the patient, including discussion before or during decisions about transfers, further treatment, assessment or other management.
What is not included
- Excludes the broader informed-consent process where the asserted concern is specifically validity of consent, material-risk disclosure, time for consideration or consent documentation.
- Excludes generic communication failures that do not concern a consequential patient-care option, decision or treatment rationale.
- Excludes failures to involve families or carers where patient-facing discussion is not the shared unsafe condition.
- Excludes failures in clinical decision-making or treatment after the relevant options and rationale were adequately discussed with the patient.
Trends
Reports over time
Reports mentioning this concern, over time
Reports about this concern issued each year.
* 2026 is projected from reports observed to 7 Sep 2026.
Most frequent recipients
Most frequent recipients
Reports about this concern sent to each recipient.
Reports and published responses 8 reports
See individual reports that have raised this concern, and the actions taken in response
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Concerns raised1
Lack of a system for involving patients in decisions about the timing of required procedures
This report raised 5 other concerns. They are not shown here because they do not form part of this recurring concern.
Linked response
- East Kent Hospitals University NHS Foundation Trust
Stated actions An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.2
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East Kent Hospitals University NHS Foundation Trust
Implement the revised Devices MDT governance documents, including referral criteria, clinical reasoning, patient involvement, escalation and action-accountability requirements.
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East Kent Hospitals University NHS Foundation Trust
Apply the strengthened MDT governance model, where appropriate, to other Cardiology Service MDTs.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
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East Kent Hospitals University NHS Foundation Trust
The specialist extraction centre, in consultation with the patient, makes the final decision about whether and when lead extraction occurs.
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Concerns raised1
Failure to provide complete information about treatment options before consent
This report raised 3 other concerns. They are not shown here because they do not form part of this recurring concern.
Linked response
- University College London Hospital (UCLH
Stated actions An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.4
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University College London Hospital (UCLH
Amend the consent policy to require additional consultant input, Best Interests Meetings where applicable, and documentation of operative and conservative-treatment risks.
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University College London Hospital (UCLH
Record subspecialty agreement to implement the amended consent policy through local governance committees.
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University College London Hospital (UCLH
Audit implementation of the amended consent policy within six months.
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University College London Hospital (UCLH
Incorporate the PFD learning into subspecialty Trust induction covering ward-round documentation and the consent policy within three months.
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Concerns raised1
Failure to provide recommendations for discussing anticoagulation withholding risks and benefits with patients
This report raised 1 other concern. They are not shown here because they do not form part of this recurring concern.
Linked response
- National Institute for Health and Care Excellence
Stated actions An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.1
-
National Institute for Health and Care Excellence
Assess the issue through the guidelines surveillance process to determine whether guidance recommendations should be updated or newly issued.
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Concerns raised1
Lack of discussion of birthing options before labour
This report raised 5 other concerns. They are not shown here because they do not form part of this recurring concern.
No linked response statementsNo respondent-stated action or position is linked to these concerns in the published data.
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Concerns raised1
Failure to discuss relevant ERCP patient factors with the patient
This report raised 5 other concerns. They are not shown here because they do not form part of this recurring concern.
Linked response
- Nottingham University Hospitals NHS Trust
Stated actions An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.2
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Nottingham University Hospitals NHS Trust
Operate two permanent consultant-staffed clinics to discuss ERCP indications, risks and alternatives with referred outpatients.
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Nottingham University Hospitals NHS Trust
Provide inpatient information booklets and obtain consent through ERCP endoscopist ward reviews before procedures.
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Concerns raised1
Insufficient discussion with patients about their care
This report raised 6 other concerns. They are not shown here because they do not form part of this recurring concern.
Linked response
- St George'S University Hospitals NHS Foundation Trust
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.2
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St George'S University Hospitals NHS Foundation Trust
Care plans and team communication were clear, although lost clinical notes prevented demonstrating that structure.
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St George'S University Hospitals NHS Foundation Trust
There were repeated discussions with the patient about amputation, despite lost records preventing corroboration.
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Concerns raised1
Failure to discuss treatment reasoning and efficacy with patients
This report raised 3 other concerns. They are not shown here because they do not form part of this recurring concern.
Linked response
- Norfolk and Suffolk NHS Foundation Trust
Stated actions An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.1
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Norfolk and Suffolk NHS Foundation Trust
Emphasise informed decision-making practice through clinical forums and the patient safety newsletter.
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Concerns raised1
Failure to ensure full and meaningful discussion before initiating the End-of-Life Care Pathway
This report raised 12 other concerns. They are not shown here because they do not form part of this recurring concern.
Linked response
- Tameside General Hospital
Stated actions An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.2
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Tameside General Hospital
Review and update the DNACPR policy to require clear, accurate communication and discussion with patients or those close to them.
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Tameside General Hospital
Create and disseminate a DNACPR policy DVD through the Trust intranet and staff screen savers.
Actions and positions describe what organisations say in published responses. Implementation is not independently verified.
Data last updated 7 September 2026