Influencing factors in surgical decision-making: a qualitative analysis of colorectal surgeons' experiences of postoperative complications.

AIM: When making anastomotic decisions in rectal cancer surgery, surgeons must consider the risk of anastomotic leakage, which bears implications for the patient's quality of life, cancer recurrence and, potentially, death. The aim of this study was to investigate the views of colorectal surgeons on how their individual attributes (e.g. experience, personality traits) may influence their decision-making and experience of complications. METHOD: This qualitative study used individual interviews for data collection. Purposive sampling was used to invite certified UK-based colorectal surgeons to participate. Participants were recruited until ongoing data review indicated no new codes were generated, suggesting data sufficiency. Data were analysed thematically following Braun and Clarke's six-step framework. RESULTS: Seventeen colorectal surgeons (eight female, nine male) participated. Two key themes with relevant subthemes were identified: (1) personal attributes influencing variation in decision-making (e.g. demographics, personality) and (2) the influence of complications on decision-making. Surgeons described variation in the management of complications based upon their personal attributes, which included factors such as gender, experience and subspeciality interests. Surgeons described the detrimental impact of anastomotic leakage on their mental and physical health. Experience of anastomotic leakage influences future decision-making and is associated with changes in practice even when a technical error is not identified. CONCLUSION: Colorectal surgeons consider anastomotic leaks to be personal 'failures', which has a negative impact on surgeon welfare. Better understanding of how surgeons make difficult decisions, and how surgeons respond to and learn from complications, is necessary to identify 'personalized' methods of supporting surgeons at all career stages, which may improve patient outcomes.

Exploring patients' needs and expectations for information on sexual dysfunction after rectal cancer treatment: A qualitative study.

AIM: Sexual dysfunction is an important, and often overlooked, sequela of rectal cancer treatment with significant implications for patients' quality of life. The aim of this study was to explore patients' information needs regarding sexual health after rectal cancer treatment and their experiences accessing information on sexual dysfunction throughout the cancer care continuum. The secondary aim was to explore surgeons' perspectives on patients' information needs and gain insight into their experiences providing information on sexual health following rectal cancer surgery. METHOD: A qualitative study was conducted using semistructured interviews with 10 rectal cancer survivors and six colorectal surgeons from a Canadian tertiary care institution. Transcribed interviews were coded independently by two researchers and thematic analysis was performed. RESULTS: Analysis of patient interviews revealed that patients had limited knowledge of sexual dysfunction symptoms following rectal cancer treatment and received inadequate information on sexual dysfunction from their treating medical team. Patients expressed the desire to receive information on sexual dysfunction in different formats, especially before the start of treatment. The surgeon interviews revealed that colorectal surgeons faced challenges when informing patients about sexual dysfunction. Surgeons did not routinely provide information on sexual dysfunction to all patients; however, they felt that patients should receive high-quality information on sexual dysfunction, both before and after treatment. CONCLUSION: Patients' information needs related to sexual dysfunction after rectal cancer treatment were inadequately met. High-quality informational resources are needed to facilitate communication between patients and physicians and improve patients' understanding of sexual dysfunction.

Treatment trajectories of individuals diagnosed with rectal cancer: an interpretative phenomenological study.

Rectal cancer affects almost every aspect of an individual's daily life. However, there are gaps in understanding the complete spectrum of experiences spanning from diagnosis to recovery. Therefore, the aim of this study was to explore the treatment trajectories of individuals diagnosed with rectal cancer. Adopting an interpretative phenomenological approach, seven participants were recruited using purposive sampling. Data were collected using semi-structured, in-depth interviews that were digitally recorded, transcribed and analysed using thematic analysis. Study rigour was established following the four-dimension criteria of credibility, dependability, transferability and confirmability. Four prominent themes emerged from the participants' experiences of undergoing rectal cancer treatment: uncovering the inner battles; navigating the physical challenges; anchors of support and conquering the summit. These findings contribute to knowledge and practice by highlighting the importance of providing a comprehensive and individualised treatment plan for individuals that takes account of the physical and psycho-emotional implications of rectal cancer treatment.

Qualitative exploration of home life experiences and care needs among elderly patients with temporary intestinal stomas.

BACKGROUND: This study employed a phenomenological research approach within qualitative research to explore the challenges encountered by elderly individuals with temporary colostomies in managing their daily lives and care needs. Protecting the anus surgery combined with temporary colostomy has emerged as a prevalent treatment modality for low rectal cancer. However, the ileostomy is susceptible to peri-stoma skin complications, as well as fluid, electrolyte, and nutritional imbalances, posing challenges to effective management. The successful self-management of patients is intricately linked to their adjustment to temporary colostomy; nonetheless, there remains a dearth of research examining the factors influencing self-care among temporary colostomy patients and the obstacles they confront. AIM: To investigate the lived experiences, perceptions, and care requirements of temporary colostomy patients within their home environment, with the ultimate goal of formulating a standardized management protocol. METHODS: Over the period of June to August 2023, a purposive sampling technique was utilized to select 12 patients with temporary intestinal stomas from a tertiary hospital in Shanghai, China. Employing a phenomenological research approach, a semi-structured interview guide was developed, and qualitative interviews were conducted using in-depth interview techniques. The acquired data underwent coding, analysis, organization, and summarization following Colaizzi's seven-step method. RESULTS: The findings of this study revealed that the experiences and needs of patients with temporary intestinal stomas can be delineated into four principal themes: Firstly, Temporary colostomy patients bear various burdens and concerns about the uncertainty of disease progression; secondly, patients exhibit limited self-care capabilities and face information deficits, resulting in heightened reliance on healthcare professionals; thirdly, patients demonstrate the potential for internal motivation through proactive self-adjustment; and finally, patients express a significant need for emotional and social support. CONCLUSION: Home-living patients with temporary intestinal stomas confront multifaceted challenges encompassing burdens, inadequate self-care abilities, informational deficits, and emotional needs. Identifying factors influencing patients' self-care at home and proposing strategies to mitigate barriers can serve as a foundational framework for developing and implementing nursing interventions tailored to the needs of patients with temporary intestinal stomas.

A latent profile analysis of psychosocial adjustment in patients with enterostomy after rectal cancer surgery.

PURPOSE: The aim of this study was to improve the level of psychosocial adjustment and quality of life of patients with enterostomy by analyzing the subgroups of psychosocial adjustment and its influencing factors. METHODS: This was a multi-center cross-sectional study. On the basis of investigating the level of psychosocial adjustment of enterostomy patients, a profile model of psychosocial adjustment of patients with enterostomy was established by using latent profile analysis. Univariate analysis and multinomial logistical regression were used to analyze the factors affecting the different psychosocial adjustment subgroups of enterostomy patients. RESULTS: Psychosocial adjustment of 3840 patients with enterostomy can be divided into three latent characteristics: Moderately high psychosocial adjustment level and high positive emotion in enterostomy patients (24.5%), Medium psychosocial but low social life adjustment (64.6%), low psychosocial adjustment level and high negative emotion (10.9%). Multinomial logistic regression showed that enterostomy self-care knowledge score, gender, medical payment method, educational background, carer, and self-care ability were affecting the subgroup classification of psychosocial adjustment of enterostomy patients. CONCLUSION: The psychosocial adjustment level of enterostomy patients can be divided into three latent profiles, which have obvious classification characteristics. Future studies can provide individualized interventions for different subgroups of enterostomy patients to improve the psychosocial adjustment of enterostomy patients.

How well do we measure the impact of bowel dysfunction on health-related quality of life after rectal cancer surgery?

BACKGROUND: Rectal cancer surgery risks causing bowel dysfunction, which has an important impact on health-related quality of life. The validity of generic tools used to measure health-related quality of life after bowel dysfunction is unclear. This study aimed to determine the content validity of health-related quality-of-life measurement tools in rectal cancer. METHODS: This was a qualitative single-center study in which adult patients who underwent rectal cancer surgery with sphincter preservation from July 2017 to October 2020 were recruited. Patients were excluded if they developed local metastasis, required a permanent stoma, or had surgery <1 year since recruitment. Telephone-based semi-structured interviews were conducted. Bowel dysfunction was measured using the Low Anterior Resection Syndrome score. Content analysis was achieved using the International Classification of Functioning framework. RESULTS: Recurrent bowel dysfunction-related concepts included "Mental functions," "Defecation functions," "Emotional functions," "Recreation and leisure," "Intimate relationships," and "Remunerative employment." A mean of 7.5 recurrent bowel dysfunction-related concepts were identified within the health-related quality of life instruments analyzed. The European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire-C30 (n = 11) and the 36-Item Short Form Health Survey (n = 9) covered the greatest number of recurrent bowel dysfunction-related concepts. Concepts such as "Mental functions," "Urination functions," "Sexual functions," "Driving," and "Mobility" were not covered by any instrument. CONCLUSION: The content of traditional health-related quality-of-life instruments is missing important areas that represent the impact of bowel dysfunction after rectal cancer surgery on health-related quality of life. These findings could help improve patient-centered care in rectal cancer surgery.

Avaliação sobre qualidade de vida relacionada à saúde em pacientes com câncer retal tratados com intenção curativa / Health-related quality of life assessment in patients with rectal cancer treated with curative intent

ABSTRACT BACKGROUND: The treatment of median and distal rectal cancer has evolved a lot in the last decades due to the dissemination of the technique of total mesortal excision and the use of neoadjuvant chemotherapy and radiotherapy. However, this multidisciplinary approach can affect patients' quality of life in a number of ways that deserve to be adequately assessed. OBJECTIVE: To evaluate immediate and late health related quality of life in patients with rectal cancer treated with curative intent. METHODS: Prospective study including patients with non-metastatic mid or low rectal cancer. EORTC QLQ-C30 and EORTC-CR38 questionnaires were applied before, 3 months and 12 months after treatment. The mean scores of the questionnaires were stratified into 4 categories for the purpose of comparing the results at different moments. RESULTS: Twenty nine patients completed the 1st and 2nd questionnaires and 12 completed the three questionaries. Patient´s mean age was 50.8 years and 62% were female. Sphincter preservation was possible in 89.6%. Overall health scores and quality of life improved after three months after 12 months. After three months, sexual satisfaction, female sexual problems and future perspective were worsen, but gastrointestinal symptoms, sphincter problems, and weight loss were improved. After 12 months the Future Perspective deteriorated, but there was improvement of the problems related to stoma, sphincter problems and body image. CONCLUSION: Despite the complexity of the treatment of rectal cancer within a specialized service, quality of life was preserved and was satisfactory in most of the studied aspects.

RESUMO CONTEXTO: O tratamento do câncer de reto médio e distal evoluiu muito nas últimas décadas devido à disseminação da técnica de excisão total do mesorretal e ao uso de quimioterapia e radioterapia neoadjuvantes. No entanto, essa abordagem multidisciplinar pode afetar a qualidade de vida dos pacientes de várias maneiras que merecem ser adequadamente avaliadas. OBJETIVO: Avaliar a qualidade de vida imediata e tardia relacionada à saúde em pacientes tratados de câncer retal com intenção curativa. MÉTODOS: Estudo prospectivo que incluiu pacientes com câncer primário de reto médio ou baixo não metastático. Foram aplicados os questionários EORTC QLQ-C30 e EORTC-CR38 antes, 3 meses e 12 meses após o tratamento. As médias dos escores dos questionários foram estratificadas em quatro categorias para fins de comparação dos resultados nos diferentes momentos. RESULTADOS: Vinte e nove pacientes responderam aos 1º e 2º questionários e 12 responderam os três questionários. A idade média foi de 50,8 anos e 62% do sexo feminino. Preservação esfincteriana foi possível em 89,6%. As médias de escores globais de saúde e qualidade de vida melhoraram tanto após 3 meses quanto após 12 meses. Função cognitiva, dor, insônia, constipação, sintomas gastrointestinais, problemas esfincterianos, perda de peso melhoraram tanto no período imediato quanto tardio. Problemas sexuais masculinos e femininos e perspectiva futura pioraram tanto no período precoce quanto tardio. As demais funções ou sintomas ou itens não se alteraram. CONCLUSÃO: Apesar da complexidade do tratamento do câncer de reto dentro de um serviço especializado, a qualidade de vida ficou preservada ou melhor na maioria das características estudadas.

Ansiedad, depresión, percepción y sentimientos de mujeres con cáncer indicadas para cirugía de exenteración pélvica / Anxiety, depression, perceptions and feelings of women with cancer referred for pelvic exenteration surgery

Objetivo: el presente estudio evalúa señales de depresión y ansiedad en mujeres con cáncer indicadas para cirugía de exenteración pélvica (EP), e identifica sus percepciones y sentimientos ante la EP. Método: Participaron en el estudio seis mujeres (37 a 64 años) que recibían tratamiento oncológico en un hospital del sur de Brasil. Las pacientes rellenaron una ficha de datos sociodemográficos y respondieron a la Escala Hospitalaria de Ansiedad y Depresión (HADS). También fueron realizadas entrevistas semiestructuradas. Resultados: En general, los resultados revelan reacciones emocionales a la indicación de EP para las participantes. Se verificó la presencia de ansiedad y depresión (50% y 66,7%, respectivamente) en el periodo preoperatorio. A partir del análisis de las entrevistas fue posible identificar dudas y temores sobre el resultado de la cirugía, así como sobre las expectativas de cura del cáncer. También aparecieron sentimientos de miedo, preocupación y ansiedad ante las ostomías. Conclusión: Estudios longitudinales pueden ampliar la comprensión del impacto de la EP, considerando también el periodo postoperatorio. Se subraya la necesidad de un seguimiento psicológico preoperatorio para mujeres indicadas para este procedimiento altamente especializado e invasivo (AU)

Objective: This study aimed to evaluate depression and anxiety in women with cancer who were referred for pelvic exenteration (PE), and to identify their perceptions and feelings regarding PE. Methods: Six women (aged between 37 and 64 years,) undergoing cancer treatment at a hospital in the city of Porto Alegre, Brazil, took part in the study. Sociodemographic data were collected and a semi-structured interview and the Hospital Anxiety and Depression Scale (HADS) were employed. Results: The overall findings revealed emotional implications related to PE. Anxiety and depression were experienced by the participants (50% and 66.7%, respectively) before the surgery. The interviews showed doubts and fears regarding the surgical outcomes as well as expectations for cancer cure. Anxiety, fear and worries associated with ostomies also emerged. Conclusion: Longitudinal studies may contribute to a broader understanding of the impact of this surgery, including the postoperative period. It is possible to highlight the need to psychological assistance before the surgery to women referred to this highly specialized and invasive medical procedure (AU)

Adaptación transcultural del cuestionario acerca de la función intestinal (LARS Score) para su aplicación en pacientes operados de cáncer de recto medio y bajo / Cross-cultural adaptation of a bowel function questionnaire (LARS Score) for application in patients operated on for medium and low rectal cancer

Introducción: El tratamiento en el cáncer de recto ha progresado en la última década. Hoy es factible ofrecer una cirugía con preservación de esfínteres, realizando anastomosis colorrectales bajas o anastomosis coloanales. Esto ha determinado que muchos pacientes desarrollen disfunción intestinal que puede llegar a ser severa, agrupando una serie de alteraciones que se conocen como síndrome de resección anterior baja. Objetivo: Efectuar una adaptación cultural de la versión 1.0 en español neutro del cuestionario acerca de la función intestinal o Low Anterior Resection Syndrome Score (LARS Score), efectuando traducción, comparación de traducciones, traducción inversa y prueba piloto. Resultados: Los resultados obtenidos de la prueba piloto revelan que la población encuestada logró comprender el instrumento, por lo que no se realizaron modificaciones posteriores. Conclusión: Se cuenta con una versión adaptada del cuestionario LARS para ser usada en Chile, la cual puede someterse a procesos de validación y establecer las características psicométricas para ser usada en pacientes con cáncer de recto operados.

Introduction: The treatment of rectal cancer has progressed in the past decade. Nowadays, it's feasible to provide sphincter sparing surgery with low colorectal anastomosis or coloanal anastomosis. This has determined that many patients develop intestinal dysfunctions that can become severe, grouping a number of disorders known as low anterior resection syndrome. Objective: To perform a cultural adaptation of the version 1.0 questionnaire about bowel function or Low Resection Syndrome Score (LARS Score) in neutral Spanish, making a translation, comparing translations, back translation and pilot test. Results: The results of the pilot test showed that the population surveyed understood the instrument, so that no further modifications were made. Conclusion: We now have an adapted version of the LARS questionnaire for use in Chile, which can undergo validation processes to establish the psychometric characteristics for use in patients with rectal cancer surgery.

Impact of Bowel Function, Anxiety and Depression on Quality of Life in Patients with Sphincter-preserving Resection for Rectal Cancer

PURPOSE: This study was a descriptive survey research to identify the impact of bowel function, anxiety and depression on quality of life in patients with rectal cancer who had a sphincter-preserving resection. METHODS: articipants were 100 patients who had rectal cancer surgery at W hospital in Korea. Bowel function, anxiety & depression, and quality of life were measured using the BFI (Bowel Function Instrument), HADS (Hospital Anxiety-Depression Scale) and the FACT-C (Functional Assessment of Cancer Therapy-Colorectal). RESULTS: The mean scores were 39.81+/-5.16 for bowel function, 6.15+/-3.25 for anxiety, 7.24+/-3.13 for depression, and 72.50+/-13.27 for quality of life. There were significant negative correlations between quality of life and anxiety (r= -.59, p <.001) and between quality of life and depression (r= -.53, p <.001). But the correlation between quality of life and bowel function was significantly positive (r=.22, p =.025). The influence of the independent variables on the total quality of life was examined using multiple regression analysis. Anxiety (beta= -.38, p =.002), bowel function (beta= -.25, p =.028) and occupation (beta=.16, p =.048) were identified as factors affecting quality of life. The explanation power of this regression model was 44% and it was statistically significant (F=16.53, p <.001). CONCLUSION: The results of this study indicate that in order to improve the bowel function of patients after sphincter-preserving resection for rectal cancer, effective nursing interventions should be developed. As psychological problem such as anxiety and depression can relate to quality of life for these patients, nurses should work on improving the situation by providing continuous emotional nursing.

Estándares de calidad de la cirugía del cáncer de recto / Quality standards in rectal cancer surgery

Los resultados en cirugía del cáncer de recto se han medido clásicamente mediante indicadores como la morbilidad, la mortalidad y la estancia hospitalaria. En los últimos años se han incluido otros parámetros que valoran la calidad asistencial, como los resultados funcionales de la técnica quirúrgica y la calidad de vida. La exéresis total del mesorrecto, realizada por cirujanos con experiencia, es la técnica quirúrgica de elección. En la actualidad es posible preservar los esfínteres en más del 70% de los casos. La dehiscencia anastomótica después de una resección anterior de recto es la complicación más grave y el factor de riesgo más importante es la altura de la anastomosis. En conjunto, la tasa global de dehiscencias debe ser inferior al 15% y la mortalidad operatoria entre el 2 y el 3%. El reservorio colónico mejora el resultado funcional por lo que es el procedimiento de elección para reconstruir el tránsito tras una resección anterior baja. La recurrencia local debe ser inferior al 10% y la supervivencia a los 5 años, entre el 70 y el 80%. En general, la calidad de vida es superior después de una resección anterior de recto en comparación con la amputación abdominoperineal a pesar del deterioro funcional que presentan algunos pacientes

The results of surgery for rectal cancer have classically been measured through indicators such as morbidity, mortality, and length of hospital stay. In the last few years other parameters have been included that evaluate healthcare quality such as the functional results of the surgical technique employed and quality of life. Total resection of the mesorectum, performed by experienced surgeons, is the surgical technique of choice. Currently, the sphincter can be preserved in 70% of patients. Anastomotic dehiscence after anterior resection of the rectum is the most serious complication and the most important risk factor is the height of the anastomosis. The overall dehiscence rate should be less than 15% and operative mortality should be between 2% and 3%. The colonic reservoir improves functional outcome and consequently it is the procedure of choice to reconstruct transit after low anterior resection. Local recurrence should be less than 10% and 5-year survival should be between 70% and 80%. In general, quality of life is better after anterior resection of the rectum than after abdominoperineal amputation, despite the functional deterioration presented by some patients