Reduction of emotional harm by a respectful approach for managing day-of-surgery cancellation: systematic development of a complex intervention

Day-of-surgery cancellations are a persistent challenge in healthcare systems worldwide, with documented emotional and time-related burdens for patients. While interventions exist to prevent cancellations, no interventions were identified that specifically addressed the management of unavoidable cancellations and their emotional impact. This study describes the systematic development of a complex intervention—Respectful Day-of-Surgery Cancellation—guided by the Medical Research Council framework and Hawkins et al.‘s co-production model, comprising: (1) evidence review and primary data collection; (2) co-production; and (3) prototyping. Data sources comprised qualitative interviews with healthcare professionals, four co-production workshops, and patient interviews for prototyping. Data were analysed using inductive content analysis. To ensure transparent reporting, the GUIDED checklist was used and intervention components were described according to the TIDieR guidance. The development process, conducted between May 2022 and December 2024, resulted in a multicomponent intervention operating at two organisational levels, comprising timely cancellation decision-making, communication skills training for nurses, and multiple components addressing patients’ informational needs throughout the cancellation trajectory. The components were integrated into a guide for respectful and supportive management of day-of-surgery cancellations, with the intended outcomes of reduced waiting time, uncertainty, and emotional distress while upholding patients’ trust in the healthcare system. The Respectful Day-of-Surgery Cancellation intervention provides a theory- and evidence-informed approach to unavoidable day-of-surgery cancellations, with respect as the guiding principle to support dignified and compassionate cancellation management. Further feasibility testing and evaluation are warranted.