Study protocols for the GEPard project: systematic analysis of sex- and gender-specific differences in the efficacy of perioperative pain management - a two-pronged approach

Introduction

Postoperative pain is common, with approximately one-third of surgical patients experiencing severe acute pain and 10–20% developing chronic post-surgical pain (CPSP). Evidence shows that female patients are at higher risk of pain after sex non-specific surgery, thus sex- or gender-specific differences in pain treatment efficacy with potential consequences for perioperative pain management are to be expected. Considering the clinical and societal burden of poorly managed postoperative pain, the GEPard project comprises two systematic reviews, GEPard 1: sex- and/or gender-specific differences in efficacy of perioperative pain management for certain (major) surgical procedures in adult patients; and GEPard 2: sex- and/or gender-specific differences in the dosing, efficacy and adverse effects of the most common systemic perioperative non-opioid- and co-analgesics across all sex non-specific surgical procedures in adult patients.

Methods and analysis

The reviews will be conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the Cochrane Handbook. MEDLINE, Embase, Cochrane Library, Web of Science, Scopus, ClinicalTrials.gov and PsycINFO will be searched. We will include randomised controlled trials (RCTs) and systematic reviews/meta-analyses reporting outcomes disaggregated by sex and/or gender in adult surgical patients. For GEPard 1, this applies to selected major surgical procedures; for GEPard 2, to all non-sex-specific surgical procedures. Interventions include regional anaesthesia, systemic analgesics and psychological strategies for GEPard 1 and non-opioid- as well as co-analgesics for GEPard 2. Two reviewers will independently screen and extract the data. Cochrane Risk of Bias Tool 2.0 (RoB 2) and AMSTAR 2 tools will assess study quality. Random-effects or Bayesian meta-analyses will be performed where possible; otherwise, narrative synthesis will be applied. GRADE methodology will assess evidence certainty.

Ethics and dissemination

No ethical approval is required for these reviews. Findings will be disseminated via peer-reviewed publications, patient organisations and professional societies. Data will be shared via Zenodo or Open Science Framework (OSF), following FAIR principles.

PROSPERO registration number

The systematic review protocols for both reviews have been registered in PROSPERO on 29 August 2025 (Registration-ID: CRD420251121393 (GEPard1), CRD420251121536 (GEPard2).

Nurses' Perceptions of Their Involvement in Shared Decision‐Making for Advanced Cancer Treatment and Palliative Care; a Qualitative Interview Study

Por: Jannicke Rabben · Mariann Fossum · Bella Vivat · Gudrun Elin Rohde

ABSTRACT

Aim

To explore nurses' perceptions of their involvement in shared decision-making for advanced cancer treatment and palliative care, and their contributions to patient involvement.

Design

Exploratory qualitative research.

Methods

In-depth interviews conducted in March–October 2023 with 15 nurses from two Norwegian hospitals were analysed using reflexive thematic analysis.

Results

Two broad themes were constructed: Theme (1) ‘Person-centredness; acquiring and sharing knowledge’; with subthemes; ‘Knowing and speaking for the person with cancer’, and ‘Providing informational, emotional and practical facilitation and support’, and Theme (2) Enacting the professional nurse role in complex situations'; with subthemes: ‘Palliative cancer care decision-making is particularly complex’, ‘Systems and cultures shape nurses’ roles and contributions', and ‘Balancing beneficence and patient autonomy’.

Conclusion

Participants perceived themselves as contributing to shared decision-making, while facing challenges and dilemmas in their professional roles. More supportive interprofessional working might improve how health professionals involve patients in shared decision-making.

Implications for the Profession and Patient Care

Increased development of nurses' contributions to shared decision-making about advanced cancer and palliative care could support their facilitation of patient involvement.

Impact

Although nurses can support people receiving palliative cancer treatment and care in shared decision-making, nursing's particular role and contribution has been unclear. Study findings suggest that nurses' important person-centred approach is challenging to maintain in treatment decision-making. These insights into nurses' involvement in shared decision-making could inform and contribute to the further development of interprofessional education, training, and leadership.

Reporting Method

COREQ.

What Does This Paper Contribute to the Wider Global Clinical Community?

Provides in-depth knowledge on nurses' perceptions of their contributions to shared decision-making with patients and caregivers. Supports an increasing focus on nurses' role in facilitating and supporting patient involvement in treatment decision-making.

Patient or Public Contribution

A patient and public involvement group participated in study design and conduct.

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