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Gaetani RS, Ladin K, Abelson JS. Journey through the Decades: The Evolution in Treatment and Shared Decision Making for Locally Advanced Rectal Cancer. Cancers (Basel) 2024; 16:2807. [PMID: 39199579 PMCID: PMC11353159 DOI: 10.3390/cancers16162807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2024] [Revised: 08/03/2024] [Accepted: 08/06/2024] [Indexed: 09/01/2024] Open
Abstract
The management of locally advanced rectal cancer has undergone significant transformations over the decades and optimal treatment approaches continue to evolve. There have been numerous advances in surgery, chemotherapy, and radiation therapy from the first description of the abdominoperineal resection in 1908, timing of chemotherapy and radiation therapy in the late 20th and early 21st century, and most recently, the introduction of organ preservation or nonoperative management in 2004. Alongside these advancements, the concept of shared decision making in medicine has evolved, prompting a focus on patient-centered care. This evolution in practice has been fueled by a growing recognition of the importance of patient autonomy and the alignment of treatment options with patients' values and preferences. With the growing number of possible treatment options, variability in patient counseling exists, highlighting the need for a standardized approach to shared decision making in locally advanced rectal cancer. This narrative review will describe the evolution of treatment options of locally advanced rectal cancer as well as the concept of shared decision making and decision aids, and will introduce a decision aid for patients with locally advanced rectal cancer who have achieved a complete clinical response and are eligible for watch and wait.
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Affiliation(s)
- Racquel S. Gaetani
- Department of Colon and Rectal Surgery, Lahey Hospital and Medical Center, Burlington, MA 01805, USA;
| | - Keren Ladin
- Department of Community Health, Tufts University, Medford, MA 02155, USA
| | - Jonathan S. Abelson
- Department of Colon and Rectal Surgery, Lahey Hospital and Medical Center, Burlington, MA 01805, USA;
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2
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Smits LJH, van Lieshout AS, Debets S, Spoor S, Moons LMG, Peeters KCMJ, van Oostendorp SE, Damman OC, Janssens RJPA, Lameris W, van Grieken NCT, Tuynman JB. Patients' perspectives and the perceptions of healthcare providers in the treatment of early rectal cancer; a qualitative study. BMC Cancer 2023; 23:1266. [PMID: 38129790 PMCID: PMC10740344 DOI: 10.1186/s12885-023-11734-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 12/08/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Shared decision-making has become of increased importance in choosing the most suitable treatment strategy for early rectal cancer, however, clinical decision-making is still primarily based on physicians' perspectives. Balancing quality of life and oncological outcomes is difficult, and guidance on patients' involvement in this subject in early rectal cancer is limited. Therefore, this study aimed to explore preferences and priorities of patients as well as physicians' perspectives in treatment for early rectal cancer. METHODS In this qualitative study, semi-structured interviews were performed with early rectal cancer patients (n = 10) and healthcare providers (n = 10). Participants were asked which factors influenced their preferences and how important these factors were. Thematic analyses were performed. In addition, participants were asked to rank the discussed factors according to importance to gain additional insights. RESULTS Patients addressed the following relevant factors: the risk of an ostomy, risk of poor bowel function and treatment related complications. Healthcare providers emphasized oncological outcomes as tumour recurrence, risk of an ostomy and poor bowel function. Patients perceived absolute risks of adverse outcome to be lower than healthcare providers and were quite willing undergo organ preservation to achieve a better prospect of quality of life. CONCLUSION Patients' preferences in treatment of early rectal cancer vary between patients and frequently differ from assumptions of preferences by healthcare providers. To optimize future shared decision-making, healthcare providers should be aware of these differences and should invite patients to explore and address their priorities more explicitly during consultation. Factors deemed important by both physicians and patients should be expressed during consultation to decide on a tailored treatment strategy.
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Affiliation(s)
- Lisanne J H Smits
- Department of Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Centre Amsterdam, De Boelelaan 1117, Amsterdam, 1081HV, the Netherlands.
| | - Annabel S van Lieshout
- Department of Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Centre Amsterdam, De Boelelaan 1117, Amsterdam, 1081HV, the Netherlands
| | - Saskia Debets
- Department of Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Centre Amsterdam, De Boelelaan 1117, Amsterdam, 1081HV, the Netherlands
| | - Sacha Spoor
- Department of Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Centre Amsterdam, De Boelelaan 1117, Amsterdam, 1081HV, the Netherlands
| | - Leon M G Moons
- Department of Gastroenterology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Koen C M J Peeters
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Olga C Damman
- Department of Public and Occupational Health, Vrije Universiteit Amsterdam, Public Health Research Institute, Amsterdam, the Netherlands
| | | | - Wytze Lameris
- Department of Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Centre Amsterdam, De Boelelaan 1117, Amsterdam, 1081HV, the Netherlands
| | - Nicole C T van Grieken
- Department of Pathology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Centre Amsterdam, Amsterdam, the Netherlands
| | - Jurriaan B Tuynman
- Department of Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Centre Amsterdam, De Boelelaan 1117, Amsterdam, 1081HV, the Netherlands
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3
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Li S, Zhu X, Zhang L, Huang C, Li D. The effect of pain-education nursing based on a mind map on postoperative pain score and quality of life in patients with colorectal cancer. Medicine (Baltimore) 2023; 102:e33562. [PMID: 37171350 PMCID: PMC10174362 DOI: 10.1097/md.0000000000033562] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
Mind mapping is a combination of images and logical thinking in the form of pictures and texts. It presents a natural expression process that conforms to the divergent thinking of the brain, helping patients understand memory. This study aimed to investigate the impact of pain-education nursing with the aid of mind maps on postoperative pain scores and quality of life in patients with colorectal cancer. The medical records of 100 colorectal cancer patients treated from July 2020 to July 2022 were selected as retrospective research participants and divided into control and observation groups. The control group received routine pain care, and the observation group was given pain-education nursing based on a mind map. The effects on quality of life, pain, negative emotions, and comfort after nursing were compared between the 2 groups. There was no significant difference in quality of-life scores between the 2 groups before the nursing intervention (P > .05). After nursing, the physical, emotional, cognitive, and social functions of patients in the observation group were significantly higher than those in the control group. However, the overall quality of life and financial difficulties of patients in the observation group were significantly lower than those in the control group (P < .05). The observation group's social, physical, and psychological comfort scores were significantly higher than those in the control group after nursing intervention (P < .05). After nursing, the observation group's visual analog scale scores at different times after the operation were significantly lower than those of the control group. The scores on the self-rating anxiety scale and self-rating depression scale in the observation group were significantly lower than those in the control group (P < .05). Pain-education nursing based on mind maps can effectively improve the daily living ability, pain symptoms, and quality of life of patients after colorectal cancer, and there is a reference value for post-nursing care of patients after colorectal cancer.
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Affiliation(s)
- Shan Li
- Pain Department Hand Surgery, Wuhan Fourth Hospital, Wuhan, Hubei, China
| | - Xiaohong Zhu
- Department of Surgery, Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi City, Hubei Province, China
| | - Lihua Zhang
- Pain Department Hand Surgery, Wuhan Fourth Hospital, Wuhan, Hubei, China
| | - Cui Huang
- Urology Gastrointestinal Surgery, Wuhan Fourth Hospital, Wuhan Fourth Hospital, Wuhan, Hubei, China
| | - Dan Li
- Urology Gastrointestinal Surgery, Wuhan Fourth Hospital, Wuhan Fourth Hospital, Wuhan, Hubei, China
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4
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Krebs ED, Hoang SC. Informed Consent and Shared Decision Making in the Perioperative Environment. Clin Colon Rectal Surg 2023; 36:223-228. [PMID: 37113280 PMCID: PMC10125277 DOI: 10.1055/s-0043-1761158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Informed consent and shared decision making (SDM) are crucial portions of preoperative patient management. Informed consent is a standard for surgery from both a legal and ethical standpoint, involving disclosure of potential risks of a procedure and ensuring patient understanding of these risks. SDM is a process in which a clinician and patients decide between two or more treatment plans, taking into account the patient's goals and values. SDM is a particularly important aspect of patient-centered care when two or more treatment options exist or in situations where an indicated treatment may not align with the patient's long-term goals. This article details aspects of and issues surrounding informed consent and SDM.
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Affiliation(s)
- Elizabeth D. Krebs
- Department of Surgery, Vanderbilt University Medical Center, Nashville Tennessee
| | - Sook C. Hoang
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
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5
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Development of a Patient Decision Aid for Rectal Cancer Patients with Clinical Complete Response after Neo-Adjuvant Treatment. Cancers (Basel) 2023; 15:cancers15030806. [PMID: 36765766 PMCID: PMC9913303 DOI: 10.3390/cancers15030806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 01/20/2023] [Accepted: 01/26/2023] [Indexed: 02/01/2023] Open
Abstract
Surgery is the primary component of curative treatment for patients with rectal cancer. However, patients with a clinical complete response (cCR) after neo-adjuvant treatment may avoid the morbidity and mortality of radical surgery. An organ-sparing strategy could be an oncological equivalent alternative. Therefore, shared decision making between the patient and the healthcare professional (HCP) should take place. This can be facilitated by a patient decision aid (PtDA). In this study, we developed a PtDA based on a literature review and the key elements of the Ottawa Decision Support Framework. Additionally, a qualitative study was performed to review and evaluate the PtDA by both HCPs and former rectal cancer patients by a Delphi procedure and semi-structured interviews, respectively. A strong consensus was reached after the first round (I-CVI 0.85-1). Eleven patients were interviewed and most of them indicated that using a PtDA in clinical practice would be of added value in the decision making. Patients indicated that their decisional needs are centered on the impact of side effects on their quality of life and the outcome of the different options. The PtDA was modified taking into account the remarks of patients and HCPs and a second Delphi round was held. The second round again showed a strong consensus (I-CVI 0.87-1).
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6
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Goldwag JL, Saunders CH, Read JT, Durand MA, Elwyn G, Ivatury SJ. A Rectal Cancer Surgical Decision Aid Is Not Enough: A Qualitative Study. Dis Colon Rectum 2022; 65:1483-1493. [PMID: 36037408 DOI: 10.1097/dcr.0000000000002444] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Rectal cancer patients often face complex surgical treatment decisions, but there are few available tools to aid in decision-making. OBJECTIVE We aimed to identify content and delivery preferences of rectal cancer patients and colorectal surgeons to guide future surgical decision aid creation. DESIGN Qualitative study: inductive thematic analysis of semi-structured interviews. SETTING In-person and phone interviews. PATIENTS We purposively sampled 15 rectal cancer survivors based on demographics and surgery type. Five caregivers also participated. We purposively selected 10 surgeons based on practice type and years of experience. INTERVENTIONS Semi-structured interviews. MAIN OUTCOME MEASURES Major and minor themes for survivors and surgeons with thematic saturation. RESULTS Interviews were a median of 61 minutes (41-93) for patients and 35 minutes (25-59) for surgeons. Nine survivors were younger than 65 years; 7 were female. Surgeons had been practicing for a mean of 10 years (SD 7.4), with 7 in academic and 3 in private settings. Participating survivors and surgeons wanted a comprehensive educational tool-not just a surgical decision aid. Survivors wanted more information on rectal cancer basics and lifestyle, care timelines, and resources during treatment. Surgeons thought patients mostly desired information about surgical options and bowel function. Both patients and surgeons wanted a tool that was personalized, simple, understandable, visually appealing, interactive, short, and in multiple formats. LIMITATIONS Results may not be generalizable due to selection bias of participants. CONCLUSION Rectal cancer survivors, their caregivers, and colorectal surgeons wanted an educational support tool that would address substantial educational needs through the continuum of disease rather than a surgical decision aid focusing on a discrete surgical choice only. See Video Abstract at http://links.lww.com/DCR/C20 . UNA AYUDA PARA LA DECISIN QUIRRGICA DEL CNCER DE RECTO NO ES SUFICIENTE UN ESTUDIO CUALITATIVO ANTECEDENTES:Los pacientes con cáncer de recto a menudo enfrentan decisiones de tratamiento quirúrgico complejas, pero hay pocas herramientas disponibles para ayudar en la toma de decisiones.OBJETIVO:Nuestro objetivo fue identificar el contenido y las preferencias de entrega de los pacientes con cáncer de recto y los cirujanos colorrectales para guiar la futura creación de ayuda para la toma de decisiones quirúrgicas.DISEÑO:Estudio cualitativo: análisis temático inductivo de entrevistas semiestructuradas.ESCENARIO:Entrevistas en persona y por teléfono.PACIENTES:Tomamos muestras intencionalmente de 15 sobrevivientes de cáncer de recto, según la demografía y el tipo de cirugía. También participaron cinco cuidadores. Seleccionamos intencionalmente a 10 cirujanos según el tipo de práctica y los años de experiencia.INTERVENCIONES:Entrevistas semiestructuradas.PRINCIPALES MEDIDAS DE RESULTADO:Temas principales y secundarios para sobrevivientes y cirujanos con saturación temática.RESULTADOS:Las entrevistas tuvieron una mediana de 61 minutos (41-93) para pacientes y 35 minutos (25-59) para cirujanos. Nueve sobrevivientes tenían menos de 65 años; siete eran mujeres. Los cirujanos habían estado ejerciendo una media de 10 años (DE 7,4), con siete en entornos académicos y 3 en entornos privados. Los sobrevivientes y cirujanos participantes querían una herramienta educativa comprensible, no solo una ayuda para la decisión quirúrgica. Los sobrevivientes querían más información sobre los conceptos básicos y el estilo de vida del cáncer de recto, los plazos de atención y los recursos durante el tratamiento. Los cirujanos pensaron que los pacientes en su mayoría deseaban información sobre las opciones quirúrgicas y la función intestinal. Tanto los pacientes como los cirujanos querían una herramienta que fuera personalizada, simple, comprensible, visualmente atractiva, interactiva, corta y en múltiples formatos.LIMITACIONES:Los resultados pueden no ser generalizables debido al sesgo de selección de los participantes.CONCLUSIÓN:Los sobrevivientes de cáncer rectal, sus cuidadores y los cirujanos colorrectales querían una herramienta de apoyo educativo que cubriera las necesidades educativas sustanciales a lo largo del tratamiento de la enfermedad en lugar de una ayuda para la decisión quirúrgica que se centre solo en una opción quirúrgica discreta. Consulte Video Resumen en http://links.lww.com/DCR/C20 . (Traducción-Dr. Yolanda Colorado ).
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Affiliation(s)
- Jenaya L Goldwag
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Catherine H Saunders
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, NH.,The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH
| | - Jackson T Read
- University of Texas at Austin Dell Medical School, Austin, TX
| | - Marie-Anne Durand
- The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH
| | - Srinivas Joga Ivatury
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH.,University of Texas at Austin Dell Medical School, Austin, TX
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Williams A, Cunningham A, Hutchings H, Harris DA, Evans MD, Harji D. Quality of internet information to aid patient decision making in locally advanced and recurrent rectal cancer. Surgeon 2022; 20:e382-e391. [PMID: 35033455 DOI: 10.1016/j.surge.2021.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/25/2021] [Accepted: 12/16/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND To review whether online decision aids are available for patients contemplating pelvic exenteration (PE) for locally advanced and recurrent rectal cancer (LARC and LRRC). METHODS A grey literature review was carried out using the Google Search™ engine undertaken using a predefined search strategy (PROSPERO database CRD42019122933). Written health information was assessed using the DISCERN criteria and International Patient Decision Aids Standards (IPDAS) with readability content assessed using the Flesch-Kincaid reading ease test and Flesch-Kincaid grade level score. RESULTS Google search yielded 27, 782, 200 results for the predefined search criteria. 131 sources were screened resulting in the analysis of 6 sources. No sources were identified as a decision aid according to the IPDAS criteria. All sources provided an acceptable quality of written health information, scoring a global score of 3 for the DISCERN written assessment. The median Flesch-Kincaid reading ease was 50.85 (32.5-80.8) equating to a reading age of 15-18 years and the median Flesch-Kincaid grade level score was 7.65 (range 3-9.7), which equates to a reading age of 13-14. CONCLUSIONS This study has found that there is a paucity of online information for patients contemplating PE. Sources that are available are aimed at a high health literate patient. Given the considerable morbidity associated with PE surgery there is a need for high quality relevant information in this area. A PDA should be developed to improve decision making and ultimately improve patient experience.
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Affiliation(s)
- A Williams
- Department of Surgery, Swansea Bay University Health Board, Singleton Hospital, Swansea, SA2 8QA, UK; Swansea University Medical School, Institute of Life Science 2, Swansea, SA2 8QA, UK.
| | - A Cunningham
- Department of Surgery, Swansea Bay University Health Board, Singleton Hospital, Swansea, SA2 8QA, UK; Swansea University Medical School, Institute of Life Science 2, Swansea, SA2 8QA, UK.
| | - H Hutchings
- Swansea University Medical School, Institute of Life Science 2, Swansea, SA2 8QA, UK.
| | - D A Harris
- Department of Surgery, Swansea Bay University Health Board, Singleton Hospital, Swansea, SA2 8QA, UK.
| | - M D Evans
- Department of Surgery, Swansea Bay University Health Board, Singleton Hospital, Swansea, SA2 8QA, UK.
| | - D Harji
- Population Health Sciences, University of Newcastle, Australia.
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Garfinkle R, Ky A, Singh A, Morin N, Ghitulescu G, Faria J, Vasilevsky CA, Boutros M. Financial and occupational impact of low anterior resection syndrome in rectal cancer survivors. Colorectal Dis 2021; 23:1777-1784. [PMID: 33724620 DOI: 10.1111/codi.15633] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/19/2021] [Accepted: 03/09/2021] [Indexed: 12/12/2022]
Abstract
AIM The aim of this study was to assess bowel-related financial stress and strain and to evaluate its association with global quality of life. METHOD This was a retrospective cohort study with cross-sectional follow-up including consecutive patients who underwent restorative proctectomy for neoplastic disease of the rectum at a single university-affiliated hospital in Montreal, Quebec, Canada. Bowel-related financial impact and occupational impact were compared between patients with major low anterior resection syndrome (LARS) and those with minor/no LARS. The association between LARS, bowel-related financial impact and global quality of life (QoL) was then assessed in a multiple logistic regression model. RESULTS Of 180 eligible rectal cancer survivors who were contacted, 154 completed the questionnaires (response rate 47.1%) at a median follow-up of 57.5 months (interquartile range 34.1-98.1) after proctectomy. Individuals with major LARS reported a higher prevalence of bowel-related financial stress (53.2% vs 5.6%, p < 0.001) and strain (42.2% vs 5.6%, p < 0.001) compared with those with minor/no LARS. Among those who were working preoperatively (n = 100), the majority of participants with major LARS reported an impact of their new bowel function on their ability to work (70.6%), including delayed return to work (44.1%), the need to change schedules (35.3%) or roles (20.6%), and complete long-term medical absence from work (14.7%). On multiple logistic regression, major LARS with financial impact (OR 4.50, 95% CI 1.57-13.77) was associated with low global QoL compared with minor/no LARS. CONCLUSION Major LARS was associated with considerable financial stress and strain and difficulties in returning to work.
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Affiliation(s)
- Richard Garfinkle
- Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, Quebec, Canada
| | - Aurelie Ky
- Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, Quebec, Canada
| | - Aashiyan Singh
- Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, Quebec, Canada
| | - Nancy Morin
- Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, Quebec, Canada
| | - Gabriela Ghitulescu
- Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, Quebec, Canada
| | - Julio Faria
- Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, Quebec, Canada
| | - Carol-Ann Vasilevsky
- Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, Quebec, Canada
| | - Marylise Boutros
- Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, Quebec, Canada
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9
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Martin RW, Brogård Andersen S, O'Brien MA, Bravo P, Hoffmann T, Olling K, Shepherd HL, Dankl K, Stacey D, Dahl Steffensen K. Providing Balanced Information about Options in Patient Decision Aids: An Update from the International Patient Decision Aid Standards. Med Decis Making 2021; 41:780-800. [PMID: 34196241 DOI: 10.1177/0272989x211021397] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The objective of this International Patient Decision Aids Standard (IPDAS) review is to update and synthesize theoretical and empirical evidence on how balanced information can be presented and measured in patient decision aids (PtDAs). METHODS A multidisciplinary team conducted a scoping review using 2 search strategies in multiple electronic databases evaluating the ways investigators defined and measured the balance of information provided about options in PtDAs. The first strategy combined a search informed by the Cochrane Review of the Effectiveness of Decision Aids with a search on balanced information. The second strategy repeated the search published in the 2013 IPDAS update on balanced presentation. RESULTS Of 2450 unique citations reviewed, the full text of 168 articles was screened for eligibility. Sixty-four articles were included in the review, of which 13 provided definitions of balanced presentation, 8 evaluated mechanisms that may introduce bias, and 42 quantitatively measured balanced with methods consistent with the IPDAS criteria in PtDAs. The revised definition of balanced information is, "Objective, complete, salient, transparent, evidence-informed, and unbiased presentation of text and visual information about the condition and all relevant options (with important elements including the features, benefits, harms and procedures of those options) in a way that does not favor one option over another and enables individuals to focus attention on important elements and process this information." CONCLUSIONS Developers can increase the balance of information in PtDAs by informing their structure and design elements using the IPDAS checklist. We suggest that new PtDA components pertaining to balance be evaluated for cognitive bias with experimental methods as well by objectively evaluating patients' and content experts' beliefs from multiple perspectives.
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Affiliation(s)
- Richard W Martin
- Michigan State University, College of Human Medicine, Grand Rapids, MI, USA
| | - Stina Brogård Andersen
- Department of Clinical Development, Odense University Hospital, Odense, Denmark.,Center for Shared Decision Making, Lillebaelt Hospital-University Hospital of Southern Denmark, Vejle, Denmark.,Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Mary Ann O'Brien
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - Paulina Bravo
- School of Nursing, Pontificia Universidad Católica de Chile, Santiago, Chile.,Millennium Nucleus Center Authority and Power Asymmetries
| | - Tammy Hoffmann
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Karina Olling
- Center for Shared Decision Making, Lillebaelt Hospital-University Hospital of Southern Denmark, Vejle, Denmark
| | - Heather L Shepherd
- University of Sydney, Faculty of Science, Psycho-Oncology Co-operative Research Group (PoCoG), School of Psychology, Sydney, Australia
| | - Kathrina Dankl
- Design School Kolding, Lab for Social Design, Kolding, Denmark
| | - Dawn Stacey
- School of Nursing, University of Ottawa, Clinical Epidemiology Program.,Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Karina Dahl Steffensen
- Center for Shared Decision Making, Lillebaelt Hospital-University Hospital of Southern Denmark, Vejle, Denmark.,Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,Department of Clinical Oncology, Lillebaelt Hospital-University Hospital of Southern Denmark, Vejle, Denmark
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10
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Hommes S, Vromans R, Clouth F, Verbeek X, de Hingh I, Krahmer E. Communication in decision aids for stage I-III colorectal cancer patients: a systematic review. BMJ Open 2021; 11:e044472. [PMID: 33926980 PMCID: PMC8094367 DOI: 10.1136/bmjopen-2020-044472] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 03/30/2021] [Accepted: 03/31/2021] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES To assess the communicative quality of colorectal cancer patient decision aids (DAs) about treatment options, the current systematic review was conducted. DESIGN Systematic review. DATA SOURCES DAs (published between 2006 and 2019) were identified through academic literature (MEDLINE, Embase, CINAHL, Cochrane Library and PsycINFO) and online sources. ELIGIBILITY CRITERIA DAs were only included if they supported the decision-making process of patients with colon, rectal or colorectal cancer in stages I-III. DATA EXTRACTION AND SYNTHESIS After the search strategy was adapted from similar systematic reviews and checked by a colorectal cancer surgeon, two independent reviewers screened and selected the articles. After initial screening, disagreements were resolved with a third reviewer. The review was conducted in concordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. DAs were assessed using the International Patient Decision Aid Standards (IPDAS) and Communicative Aspects (CA) checklist. RESULTS In total, 18 DAs were selected. Both the IPDAS and CA checklist revealed that there was a lot of variation in the (communicative) quality of DAs. The findings highlight that (1) personalisation of treatment information in DAs is lacking, (2) outcome probability information is mostly communicated verbally and (3) information in DAs is generally biased towards a specific treatment. Additionally, (4) DAs about colorectal cancer are lengthy and (5) many DAs are not written in plain language. CONCLUSIONS Both instruments (IPDAS and CA) revealed great variation in the (communicative) quality of colorectal cancer DAs. Developers of patient DAs should focus on personalisation techniques and could use both the IPDAS and CA checklist in the developmental process to ensure personalised health communication and facilitate shared decision making in clinical practice.
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Affiliation(s)
- Saar Hommes
- Tilburg center for Cognition and Communication (TiCC), Tilburg School of Humanities and Digital Sciences (TSHD), Department of Communication and Cognition, Tilburg University, Tilburg, The Netherlands
- The Netherlands Comprehensive Cancer Organization, Department of Research & Development, IKNL, Eindhoven, The Netherlands
| | - Ruben Vromans
- Tilburg center for Cognition and Communication (TiCC), Tilburg School of Humanities and Digital Sciences (TSHD), Department of Communication and Cognition, Tilburg University, Tilburg, The Netherlands
- The Netherlands Comprehensive Cancer Organization, Department of Research & Development, IKNL, Eindhoven, The Netherlands
| | - Felix Clouth
- The Netherlands Comprehensive Cancer Organization, Department of Research & Development, IKNL, Eindhoven, The Netherlands
- Department of Methodology and Statistics, Tilburg University, Tilburg, The Netherlands
| | - Xander Verbeek
- The Netherlands Comprehensive Cancer Organization, Department of Research & Development, IKNL, Eindhoven, The Netherlands
| | - Ignace de Hingh
- Catharina Cancer Institute, Colorectal Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Emiel Krahmer
- Tilburg center for Cognition and Communication (TiCC), Tilburg School of Humanities and Digital Sciences (TSHD), Department of Communication and Cognition, Tilburg University, Tilburg, The Netherlands
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Collée GE, van der Wilk BJ, van Lanschot JJB, Busschbach JJ, Timmermans L, Lagarde SM, Kranenburg LW. Interventions that Facilitate Shared Decision-Making in Cancers with Active Surveillance as Treatment Option: a Systematic Review of Literature. Curr Oncol Rep 2020; 22:101. [PMID: 32725550 PMCID: PMC7387328 DOI: 10.1007/s11912-020-00962-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
PURPOSE OF REVIEW Medical decisions concerning active surveillance are complex, especially when evidence on superiority of one of the treatments is lacking. Decision aids have been developed to facilitate shared decision-making on whether to pursue an active surveillance strategy. However, it is unclear how these decision aids are designed and which outcomes are considered relevant. The purpose of this study is to systematically review all decision aids in the field of oncological active surveillance strategies and outcomes used by authors to assess their efficacy. RECENT FINDINGS A search was performed in Embase, Medline, Web of Science, Cochrane, PsycINFO Ovid and Google Scholar until June 2019. Eligible studies concerned interventions aiming to facilitate shared decision-making for patients confronted with several treatment alternatives, with active surveillance being one of the treatment alternatives. Twenty-three eligible articles were included. Twenty-one articles included patients with prostate cancer, one with thyroid cancer and one with ovarian cancer. Interventions mostly consisted of an interactive web-based decision aid format. After categorization of outcomes, seven main groups were identified: knowledge, involvement in decision-making, decisional conflict, treatment preference, decision regret, anxiety and health-related outcomes. Although active surveillance has been implemented for several malignancies, interventions that facilitate shared decision-making between active surveillance and other equally effective treatment alternatives are scarce. Future research should focus on developing interventions for malignancies like rectal cancer and oesophageal cancer as well. The efficacy of interventions is mostly assessed using short-term outcomes.
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Affiliation(s)
- G E Collée
- Department of Psychiatry, Section Medical Psychology and Psychotherapy, Erasmus MC - University Medical Centre, Rotterdam, Netherlands
| | - B J van der Wilk
- Department of Surgery, Erasmus MC - University Medical Centre, Dr. Molewaterplein 40 P.O. Box 2040, Suite Na-2119, 3015 GD, Rotterdam, Netherlands.
| | - J J B van Lanschot
- Department of Surgery, Erasmus MC - University Medical Centre, Dr. Molewaterplein 40 P.O. Box 2040, Suite Na-2119, 3015 GD, Rotterdam, Netherlands
| | - J J Busschbach
- Department of Psychiatry, Section Medical Psychology and Psychotherapy, Erasmus MC - University Medical Centre, Rotterdam, Netherlands
| | - L Timmermans
- Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, Netherlands
| | - S M Lagarde
- Department of Surgery, Erasmus MC - University Medical Centre, Dr. Molewaterplein 40 P.O. Box 2040, Suite Na-2119, 3015 GD, Rotterdam, Netherlands
| | - L W Kranenburg
- Department of Psychiatry, Section Medical Psychology and Psychotherapy, Erasmus MC - University Medical Centre, Rotterdam, Netherlands
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Goldwag J, Marsicovetere P, Scalia P, Johnson HA, Durand MA, Elwyn G, Ivatury SJ. The impact of decision aids in patients with colorectal cancer: a systematic review. BMJ Open 2019; 9:e028379. [PMID: 31515416 PMCID: PMC6747873 DOI: 10.1136/bmjopen-2018-028379] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES Our aim was to conduct a systematic review of the literature to determine the impact of patient decision aids (PDA) on patients facing treatment decisions for colorectal cancer. DESIGN Systematic review. DATA SOURCES Sources included Embase, Medline, Web of Science, CINAHL and the Cochrane Library from inception to June, 20, 2019. ELIGIBILITY CRITERIA We included randomised controlled trials (RCTs), cohort studies, mixed methods and case series in which a PDA for colorectal cancer treatment was used. Qualitative studies were excluded from our review. DATA EXTRACTION AND SYNTHESIS Following execution of the search strategy by a medical librarian, two blinded independent reviewers identified articles for inclusion. Two blinded reviewers were also responsible for data extraction, risk of bias and study quality assessments. Any conflict in article inclusion or extraction was resolved by discussion. RESULTS Out of 3773 articles identified, three met our inclusion criteria: one RCT, one before-and-after study and one mixed-method study. In these studies, the use of a PDA for colorectal cancer treatment was associated with increased patient knowledge, satisfaction and preparation for making a decision. On quality assessment, two of three studies were judged to be of low quality. CONCLUSION A paucity of evidence exists on the effect of PDA for colorectal cancer treatment with existing evidence being largely of low quality. Further investigation is required to determine the effect of decision aids for colorectal cancer treatment as well as reasons for the lack of PDA development and implementation in this area. PROSPERO REGISTRATION NUMBER CRD42018095153.
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Affiliation(s)
- Jenaya Goldwag
- Department of Surgery, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
- Clinical Education, Geisel School of Medicine, Hanover, New Hampshire, USA
| | - Priscilla Marsicovetere
- Clinical Education, Geisel School of Medicine, Hanover, New Hampshire, USA
- Master of Physician Assistant Studies Program, Franklin Pierce University, West Lebanon, New Hampshire, USA
| | - Peter Scalia
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire, USA
| | - Heather A Johnson
- Clinical Education, Geisel School of Medicine, Hanover, New Hampshire, USA
- Biomedical Libraries, Dartmouth College, Hanover, New Hampshire, USA
| | - Marie-Anne Durand
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire, USA
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire, USA
| | - Srinivas J Ivatury
- Department of Surgery, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
- Clinical Education, Geisel School of Medicine, Hanover, New Hampshire, USA
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Implementation of a Postoperative Screening and Treatment Guidance for the Low Anterior Resection Syndrome: Preliminary Results. Dis Colon Rectum 2019; 62:1033-1042. [PMID: 31318775 DOI: 10.1097/dcr.0000000000001428] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Even years after a low anterior resection, many patients experience persisting bowel complaints. This is referred to as low anterior resection syndrome and has a severe adverse effect on quality of life. Its diverse nature makes it difficult to find a gold-standard therapy for this syndrome. However, most importantly, postoperative guidance appears to be suboptimal. OBJECTIVE The purpose of this study was to describe and evaluate the implementation of a multimodel guidance with structured screening and treatment options. DESIGN A retrospective, comparative, cross-sectional study was conducted. Data of patients treated before protocol implementation were compared with a cohort after implementation. SETTINGS This was a single-center study. PATIENTS Patients seen after low anterior resection or sigmoid resection between 2010 and 2017 for colorectal malignancy were included. INTERVENTION This included implementation of a postoperative guidance protocol. MAIN OUTCOME MEASURES Bowel dysfunction was assessed by the low anterior resection score, whereas the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaires (C30 and CR29) assessed general and colorectal-specific quality of life. RESULTS A total of 243 patients were included; 195 were guided before and 48 after protocol implementation. Patients who underwent low anterior resection after protocol implementation showed significantly lower median low anterior resection scores (31 vs 18; p = 0.02) and less major low anterior resection syndrome (51.9% vs 26.3%; p = 0.045). Patients who underwent sigmoid resection did not present with similar changes. Multiple quality-of-life domains showed clinically significant positive changes since our postoperative protocol was implemented. LIMITATIONS Patient characteristics are not comparable between groups, which makes it difficult to draw firm conclusions. CONCLUSIONS We recommend that others reconsider their current postoperative management for patients with rectal cancer and suggest a change to a comparable noninvasive, patient-driven postoperative guidance to enhance patient coping mechanisms and self-management and therefore improve their quality of life. See Video Abstract at http://links.lww.com/DCR/A970. IMPLEMENTACIÓN DE UNA GUÍA POSTOPERATORIA DE DETECCIÓN Y TRATAMIENTO PARA EL SÍNDROME DE RESECCIÓN ANTERIOR BAJA: RESULTADOS PRELIMINARES: Incluso años después de una resección anterior baja, muchos pacientes experimentan quejas intestinales persistentes. Esto se conoce como síndrome de resección anterior baja y tiene un efecto adverso grave en la calidad de vida. Su naturaleza diversa hace que sea difícil encontrar una terapia patrón de oro para este síndrome. Pero lo más importante, la guía postoperatoria parece ser subóptima. OBJETIVO Describir y evaluar la implementación de una guía de múltiples modelos con opciones estructuradas de selección y tratamiento. DISENO Se realizó un estudio retrospectivo de corte transversal comparativo. Los datos de los pacientes tratados antes de la implementación del protocolo se compararon con una cohorte después de la implementación. MARCO Centro de estudio único. PACIENTES Pacientes después de resección anterior baja o resección sigmoidea entre 2010-2017 por neoplasia colorectal. INTERVENCIÓN:: La implementación de un protocolo de guía postoperatoria. PRINCIPALES MEDIDAS DE RESULTADO La disfunción intestinal se evaluó mediante la puntuación de resección anterior baja, mientras que la Organización Europea para la Investigación y Tratamiento de Cuestionarios de Calidad de Vida del Cáncer (C30 y CR29) evaluó la calidad de vida general y específicamente colorectal. RESULTADOS Se incluyeron 243 pacientes, 195 fueron guiados antes y 48 después de la implementación del protocolo. Los pacientes que se sometieron a una resección anterior baja después de la implementación del protocolo mostraron puntuaciones de resección anterior bajas medias significativamente más bajas (31 frente a 18; p = 0,02) y menos puntuaciones de síndrome de resección anterior baja (51,9% frente a 26,3%; p = 0,045). Los pacientes sometidos a resección sigmoidea no presentaron cambios similares. Los múltiples dominios de calidad de vida mostraron cambios positivos clínicamente significativos desde que se implementó nuestro protocolo postoperatorio. LIMITACIONES Las características de los pacientes no son comparables entre los grupos, lo que dificulta sacar conclusiones firmes. CONCLUSIÓNES:: Recomendamos a otros que reconsideren su manejo postoperatorio actual para pacientes con cáncer de recto y sugerimos un cambio a una guía postoperatoria impulsada por el paciente no invasiva comparable para mejorar los mecanismos de afrontamiento y el autocontrol de los pacientes y, por lo tanto, mejorar su calidad de vida. Vea el Video del Resumen en http://links.lww.com/DCR/A970.
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Building Decision Analysis Tools Through Systematic Review of the Literature: The Importance of Study Quality. Dis Colon Rectum 2019; 62:1-2. [PMID: 30531262 DOI: 10.1097/dcr.0000000000001185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Walming S, Asplund D, Block M, Bock D, Gonzalez E, Rosander C, Rosenberg J, Angenete E. Patients with rectal cancer are satisfied with in-hospital communication despite insufficient information regarding treatment alternatives and potential side-effects. Acta Oncol 2018; 57:1311-1317. [PMID: 29989469 DOI: 10.1080/0284186x.2018.1484158] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
AIM Patients with rectal cancer may undergo treatment such as surgery and (chemo)radiotherapy. Before treatment, patients are informed of different options and possible side-effects. The aim of the study was to evaluate the patients' experience of communication with healthcare personnel at time of diagnosis and after one year. METHOD A total of 1085 patients from Denmark and Sweden were included. They answered a detailed questionnaire at diagnosis and at the one year follow-up. Clinical data were retrieved from national quality registries. RESULTS Response rates were 87% at baseline and 74% at one year. Overall the patients were very satisfied with the communication with healthcare personnel. However, some patients reported insufficient information regarding treatment options and possible side-effects. Only 32% (335/1050) and 24% (248/1053), respectively, stated that they were informed about possible sexual and urinary dysfunction before treatment. CONCLUSIONS Even though patients felt that they received insufficient information regarding side-effects on sexual and urinary function, they were generally satisfied with the communication with the healthcare personnel. Since overall satisfaction with the level of information was very high, it is unlikely that further information to patients with rectal cancer in the surgical and oncological settings will improve satisfaction with communication.
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Affiliation(s)
- Sofie Walming
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, SSORG – Scandinavian Surgical Outcomes Research Group, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
| | - Dan Asplund
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, SSORG – Scandinavian Surgical Outcomes Research Group, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
| | - Mattias Block
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, SSORG – Scandinavian Surgical Outcomes Research Group, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
| | - David Bock
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, SSORG – Scandinavian Surgical Outcomes Research Group, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
| | - Elisabeth Gonzalez
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, SSORG – Scandinavian Surgical Outcomes Research Group, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
| | - Carina Rosander
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, SSORG – Scandinavian Surgical Outcomes Research Group, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
| | - Jacob Rosenberg
- Department of Surgery, Herlev Hospital, Denmark and Danish Colorectal Cancer Group, Herlev, Denmark
| | - Eva Angenete
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, SSORG – Scandinavian Surgical Outcomes Research Group, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
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Utility Scores and Preferences for Surgical and Organ-Sparing Approaches for Treatment of Intermediate and High-Risk Rectal Cancer. Dis Colon Rectum 2018; 61:911-919. [PMID: 29697477 DOI: 10.1097/dcr.0000000000001029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Organ-sparing approaches, including wait-and-see and local excision, are increasingly being offered to patients with rectal cancer following a good response to neoadjuvant therapy. Preferences regarding these treatment strategies are yet unknown. OBJECTIVE This study aimed to determine the preferences and utility scores for rectal cancer treatment approaches. DESIGN This is a cross-sectional study. SETTING This study was conducted at the Radiation-Oncology Department of the University Medical Center Utrecht. PATIENTS Fifty-seven patients with a history of rectal cancer and 38 volunteers were included. MAIN OUTCOME MEASURES Participants assessed 6 hypothetical treatment-outcome scenarios, including short-course radiotherapy or chemoradiation followed by abdominoperineal resection, low anterior resection, local excision, or a wait-and-see approach. The hierarchy in preferences between scenarios was assessed by using ranking. Utilities were estimated with a visual analog scale and time trade-off. RESULTS Organ-sparing approaches were ranked as the first preferred treatment option by 51% of the participants. Among all scenarios, wait-and-see was most often ranked highest by patients and volunteers (36% and 50%). Meanwhile, a substantial proportion ranked wait-and-see as their lowest preference (38% in patients and 35% in volunteers). Utility scores differed significantly between scenarios. Wait-and-see received a significantly higher score on the visual analog scale than the scenarios including abdominoperineal resection and the scenario including chemoradiation with low anterior resection, and a score similar to the scenarios including local excision and short-course radiotherapy with low anterior resection. LIMITATIONS The study population consisted of patients with a history of rectal cancer treatment and volunteers related to patients. This may have influenced preferences. CONCLUSIONS This study suggests that there is a wide disparity in preferences concerning organ-sparing approaches for rectal cancer in both patients with a history of rectal cancer and volunteers. Wait-and-see is often the highest preferred treatment, but it is also among the least preferred treatment options. These findings give insights into how patients may value the current rectal cancer treatment options. See Video Abstract at http://links.lww.com/DCR/A521.
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Zhang JE, Wong FKY, Zheng MC. The preoperative reaction and decision-making process regarding colostomy surgery among Chinese rectal cancer patients. Eur J Oncol Nurs 2017; 28:107-113. [DOI: 10.1016/j.ejon.2017.03.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 03/26/2017] [Accepted: 03/29/2017] [Indexed: 10/19/2022]
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Incorporating Shared Decision Making into Perioperative Care of Older Adults. CURRENT SURGERY REPORTS 2016. [DOI: 10.1007/s40137-016-0148-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Center the Patient in the Decision Process: A Tool to Inform the Consent and Share the Decision-Making in Patients With Rectal Cancer. Dis Colon Rectum 2016; 59:163-4. [PMID: 26855388 DOI: 10.1097/dcr.0000000000000527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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