TP6.1.5 The Importance of the Patient Voice in Metastatic Colorectal Cancer: A Qualitative Study

Abstract

Abstract Aims Colorectal cancer is the fourth commonest cancer in the UK with a third presenting with synchronous liver metastases. Although there is a large body of clinical cohort data, there is no research exploring patient perspectives of disease. This qualitative phenomenological study explores the lived experiences of patients following treatment for synchronous disease. Methods Qualitative interviews used pre-prepared prompts encouraging open dialogue and were transcribed for thematic analysis. Results Four major themes emerged. (1) Experience of Cancer The initial diagnosis was recalled in vivid detail, with delays perceived negatively particularly if clinicians were dismissive about their concerns. Caregiver participation was valued in consultations. Patients with recurrence perceived chemotherapy as a method of control. (2) Patient Autonomy Patients describe a paternalistic relationship with their clinician and were satisfied with their management despite any complications or recurrence. There was little perception of pathway equipoise with some questioning any real choice particularly those with a symptomatic bowel primary. (3) Treatment Strategy Patients preferred a bowel-first strategy as a method of control, perceiving the primary to continually seed the body with metastases. Chemotherapy offered little reassurance for disease control. Synchronous resection was preferred but the greater potential for complications was appreciated. (4) Research No patients expressed ethical concerns about potential studies randomising to different surgical strategies. However, patients would not want a liver-first strategy. Conclusions This is the first qualitative study exploring patient perceptions of metastatic colorectal cancer. The importance of the first consultation outlining management is emphasised as a simple but important message.