Abstract
BackgroundColorectal cancer is common in North America. Two surgical options exist for rectal cancer patients: low anterior resection with re-establishment of bowel continuity, and abdominoperineal resection with a permanent stoma. A rectal cancer decision aid was developed using the International Patient Decision Aid Standards to facilitate patients being more actively involved in making this decision with the surgeon. The overall aim of this study is to evaluate this decision aid and explore barriers and facilitators to implementing in clinical practice.MethodsFirst, a pre- and post- study will be guided by the Ottawa Decision Support Framework. Eligible patients from a colorectal cancer center include: 1) adult patients diagnosed with rectal cancer, 2) tumour at a maximum of 10 cm from anal verge, and 3) surgeon screened candidates eligible to consider both low anterior resection and abdominoperineal resection. Patients will be given a paper-version and online link to the decision aid to review at home. Using validated tools, the primary outcomes will be decisional conflict and knowledge of surgical options. Secondary outcomes will be patient’s preference, values associated with options, readiness for decision-making, acceptability of the decision aid, and feasibility of its implementation in clinical practice. Proposed analysis includes paired t-test, Wilcoxon, and descriptive statistics.Second, a survey will be conducted to identify the barriers and facilitators of using the decision aid in clinical practice. Eligible participants include Canadian surgeons working with rectal cancer patients. Surgeons will be given a pre-notification, questionnaire, and three reminders. The survey package will include the patient decision aid and a facilitators and barriers survey previously validated among physicians and nurses. Principal component analysis will be performed to determine common themes, and logistic regression will be used to identify variables associated with the intention to use the decision aid.DiscussionThis study will evaluate the impact of the rectal cancer decision aid on patients and help with planning strategies to overcome barriers and facilitate implementation of the decision aid in routine clinical practice. To our knowledge this is the first study designed to evaluate a decision aid in the field of colorectal surgery.
Highlights
Colorectal cancer is common in North America
It was once believed that avoiding a permanent stoma would improve quality of life, recent literature has questioned the validity of that claim [3,4,5,6]
Given the equivalent survival outcomes, and the need to weigh quality of life (QoL) outcomes, the decision for rectal cancer surgery is a value-laden one that deserves the consideration of the patient perspective
Summary
Two surgical options exist for rectal cancer patients: low anterior resection with re-establishment of bowel continuity, and abdominoperineal resection with a permanent stoma. It was once believed that avoiding a permanent stoma would improve quality of life, recent literature has questioned the validity of that claim [3,4,5,6]. Results for overall quality of life (QoL), despite being measured by various validated instruments, were consistently equivocal [7]. A recently updated Cochrane Review has revealed that low anterior resection (LAR) did not lead to superior QoL [8]. Given the equivalent survival outcomes, and the need to weigh QoL outcomes, the decision for rectal cancer surgery is a value-laden one that deserves the consideration of the patient perspective
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