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Joshua TG, Robitaille S, Paradis T, Maalouf MF, Feldman LS, Fiore JF, Liberman S, Lee L. Decision-making preferences and regret in rectal cancer patients undergoing restorative proctectomy: A prospective cohort study. Surgery 2024; 176:1065-1071. [PMID: 38997862 DOI: 10.1016/j.surg.2024.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 04/03/2024] [Accepted: 05/13/2024] [Indexed: 07/14/2024]
Abstract
BACKGROUND How patients make treatment choices in rectal cancer is poorly understood and may affect long-term regret and satisfaction. The objective of this study is to characterize decision-making preferences and their effect on decisional regret in patients undergoing restorative proctectomy for rectal cancer. METHODS A prospective cohort study was conducted in a single academic specialist rectal cancer center from October 2018 to June 2022. Adult patients who underwent restorative proctectomy at least one year prior were recruited. Health literacy was assessed using the BRIEF instrument. Decision-making preferences regarding cancer treatment were assessed using the Control Preferences Scale. Decisional regret regarding their choice of restorative proctectomy was assessed using the Decision Regret Score. Bowel dysfunction was measured using the low anterior resection syndrome score. RESULTS Overall, 123 patients were included. Health literacy was categorized as adequate in 63%, marginal in 25%, and limited in 12%. Patients with adequate health literacy were more likely to prefer a collaborative decision-making role compared with those with low health literacy (86% vs 65%, P = .016). Patients with incongruence between preferred and actual decision-making roles were more likely to report high regret (56% vs 25%, P = .003). Patients with major low anterior resection syndrome were also more likely to experience high regret compared with patients with no/minor low anterior resection syndrome (44% vs 25%, P = .036). CONCLUSION A significant proportion of patients with rectal cancer undergoing restorative proctectomy do not have a decision-making role that is congruent with their preferences, and these patients experience a high degree of regret.
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Affiliation(s)
- Temitope G Joshua
- Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada; Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Health Centre, Montreal, Quebec, Canada. https://twitter.com/temitopegjoshua
| | - Stephan Robitaille
- Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada; Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Health Centre, Montreal, Quebec, Canada. https://twitter.com/sarobitaille
| | - Tiffany Paradis
- Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada; Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Health Centre, Montreal, Quebec, Canada. https://twitter.com/tiffparadis
| | - Michael F Maalouf
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Health Centre, Montreal, Quebec, Canada. https://twitter.com/michaelmaalouf_
| | - Liane S Feldman
- Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada; Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Health Centre, Montreal, Quebec, Canada. https://twitter.com/lianefeldman
| | - Julio F Fiore
- Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada; Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Health Centre, Montreal, Quebec, Canada. https://twitter.com/juliofiorejr
| | - Sender Liberman
- Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada; Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Health Centre, Montreal, Quebec, Canada. https://twitter.com/senderliberman
| | - Lawrence Lee
- Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada; Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Health Centre, Montreal, Quebec, Canada.
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Kim H, Kim H, Cho OH. Bowel dysfunction and lower urinary tract symptoms on quality of life after sphincter-preserving surgery for rectal cancer: A cross-sectional study. Eur J Oncol Nurs 2024; 69:102524. [PMID: 38382154 DOI: 10.1016/j.ejon.2024.102524] [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: 11/25/2023] [Revised: 01/29/2024] [Accepted: 02/04/2024] [Indexed: 02/23/2024]
Abstract
OBJECTIVES This study aimed to investigate the impact of bowel dysfunction and lower urinary tract symptoms on the quality of patients with rectal cancer who underwent sphincter-preserving surgery. METHODS This cross-sectional study included patients who were followed up after sphincter-preserving surgery in Korea. Data were collected from May 2022 to February 2023. The participants (n = 110) responded to self-reported questionnaires assessing the Low Anterior Resection Syndrome (LARS) score, International Prostate Symptom Score (IPSS), European Organization for Research and Treatment of Cancer QLQ-C30 and QLQ-C29 questionnaires. RESULTS Among the participants, 66.4% had major low anterior resection syndrome, and 39.1% had moderate-to-severe lower urinary tract symptoms. Patients with higher severity of low anterior resection syndrome and lower urinary tract symptoms had a lower quality of life. The IPSS, performance status, duration since the end of the surgery, comorbidities, LARS scores, and tumor location on the anal verge negatively affected the quality of life. CONCLUSION Patients with more severe bowel dysfunction or lower urinary tract symptoms have a poorer quality of life. Nurses should be made aware of the factors that can reduce the quality of life of patients who have undergone sphincter-preserving surgery. Accordingly, they should plan to address the various nursing problems.
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Affiliation(s)
- Hyekyung Kim
- Department of Nursing, Catholic Kwandong University, Gangneung, Republic of Korea.
| | - Hyedan Kim
- Advanced Practice Nurse, Cancer Center, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.
| | - Ok-Hee Cho
- Department of Nursing, College of Nursing and Health, Kongju National University, Gongju, Republic of Korea.
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Burch J, Taylor C, Wilson A, Norton C. "You're just on your own": Exploring bowel symptom management needs after rectal cancer surgery through patient and clinician focus groups. Eur J Oncol Nurs 2023; 67:102406. [PMID: 37804751 DOI: 10.1016/j.ejon.2023.102406] [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: 01/08/2023] [Revised: 07/11/2023] [Accepted: 08/26/2023] [Indexed: 10/09/2023]
Abstract
PURPOSE Currently cancer survivorship often leaves the needs of patients unidentified and unmet. The study aims to establish the views of experts on managing bowel symptoms following rectal cancer surgery. METHOD People living with bowel symptoms as well as clinicians with expertise in rectal cancer and subsequent bowel changes were invited to participate in online focus groups. Focus groups were recorded, transcribed verbatim and analysed using a modified framework analysis. Results were presented narratively with interpretations and quotations. RESULTS Fourteen patients following rectal cancer treatment attended one of two focus groups. Sixteen clinicians attended one of four groups. Participants described their opinions about bowel symptom management. Three themes were described by both patients and clinicians: expectations of bodily changes, supported self-repair and knowledgeable self-repair. Data from participants frequently concurred; all recognised clinicians needed to support and empower patients to independently manage their cancer consequences. CONCLUSION Well-managed expectations enable patients to set realistic goals and make plans. Clinicians need to support patients to understand potential bowel changes that might occur after rectal cancer surgery, providing support, information and signposting to other relevant information and colleagues. Effective communication through avoidance of jargon and rapport building as well as providing a point of contact help prevent patients feeling alone with their symptoms. Education is needed by both clinicians and patients to ensure consistent and useful advice is provided and understood. A recommendation from the focus groups is to create opportunities for patients to access information with clinician support and signposting.
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Affiliation(s)
- Jennie Burch
- Department of Surgery, St Mark's Hospital, London, UK.
| | - Claire Taylor
- Department of Surgery, London North West University Healthcare NHS Trust, London, UK
| | - Ana Wilson
- Wolfson Unit for Endoscopy, St Mark's Hospital and Department of Surgery and Cancer, Imperial College London, UK
| | - Christine Norton
- Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
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