Exploring decision making for treatment in LARC and LRRC: A qualitative study

Decision-making in locally advanced (LARC) and locally recurrent rectal cancer (LRRC) has transformed over recent years. Informed consent and shared decision making have allowed patients to consider what information and factors are individually important to them. There is a limited understanding of the complexities of decision-making in patients undergoing pelvic exenteration (PE) for rectal cancer. The aim of this study was to explore patients and clinicians' perceptions on factors important during the decision-making process.

A prospective, cross-sectional, qualitative study was undertaken using in-depth virtual telephone audio recorded interviews across five UK centres between January and October 2020 with both patients and healthcare professionals (HCPs). The transcripts were imported into NVIVO 12 (QSR International Pty Ltd., Melbourne, Australia) and coded using the principles of thematic content analysis.

Thirty-three interviews (25 patients (76 %) and 8 HCPs (24 %)) were conducted. Thirteen males (52 %) and 12 females (48 %) with a median age of 59 years (range 36-73) were recruited. Median time elapsed between surgery and interview was 7 months (range 3-11). Six themes emerged relevant to decision-making including: communication, recovery, psychological impact, relationships, lifestyle, support. Healthcare professionals focus primarily on treatment expectations, recovery, and psychological impact.

Our study highlights the differing perspectives of patient and HCPs priorities during the decision-making process for PE. Our findings have direct relevance to framing pre-operative counselling discussions in helping patients decide on individual treatment decisions. Policy makers and clinicians need to ensure we are meeting patients' informational needs by investing into a standardised dedicated service throughout the UK.