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Patient Expectations of Functional Outcomes After Rectal Cancer Surgery: A Qualitative Study

Park, Jason M.D., M.Ed.1; Neuman, Heather B. M.D., M.S.2; Bennett, Antonia V. Ph.D.3; Polskin, Lily B.S.N., M.P.A.4; Phang, P. Terry M.D.5; Wong, W. Douglas M.D.4; Temple, Larissa K. M.D., M.Sc.4

Diseases of the Colon & Rectum:
doi: 10.1097/DCR.0000000000000036
Original Contributions: Colorectal/Anal Neoplasia
Abstract

BACKGROUND: Rectal cancer patients’ expectations of health and function may affect their disease- and treatment-related experience, but how patients form expectations of postsurgery function has received little study.

OBJECTIVE: We used a qualitative approach to explore patient expectations of outcomes related to bowel function after sphincter-preserving surgery for rectal cancer.

DESIGN: This was a cohort study of patients who were about to undergo sphincter-preserving surgery for rectal cancer.

SETTINGS: The study was conducted through individual telephone interviews with participants.

PATIENTS: Twenty-six patients (14 men and 12 women) with clinical TNM stage I to III disease were enrolled.

MAIN OUTCOME MEASURES: The semistructured interview script contained open-ended questions on patient expectations of postoperative bowel function and its perceived impact on daily function and life. Two researchers analyzed the interview transcripts for emergent themes using a grounded theory approach.

RESULTS: Participant expectations of bowel function reflected 3 major themes: 1) information sources, 2) personal attitudes, and 3) expected outcomes. The expected outcomes theme contained references to specific symptoms and participants’ descriptions of the certainty, importance, and imminence of expected outcomes. Despite multiple information sources and attempts at maintaining a positive personal attitude, participants expressed much uncertainty about their long-term bowel function. They were more focused on what they considered more important and imminent concerns about being cancer free and getting through surgery.

LIMITATIONS: This study was limited by context in terms of the timing of interviews (relative to the treatment course). The transferability to other contexts requires further study.

CONCLUSIONS: Patient expectations of long-term functional outcomes cannot be considered outside of the overall context of the cancer experience and the relative importance and imminence of cancer- and treatment-related events. Recognizing the complexities of the expectation formation process offers opportunities to develop strategies to enhance patient education and appropriately manage expectations, attend to immediate and long-term concerns, and support patients through the treatment and recovery process.

Author Information

1Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada

2Department of Surgery, University of Wisconsin, Madison, Wisconsin

3Department of Health Policy and Management, University of North Carolina, Chapel Hill, North Carolina

4Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York

5Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada

Funding/Support: Dr Temple was supported by an American Society for Clinical Oncology Career Development Award.

Financial Disclosure: None reported.

Correspondence: Jason Park, M.D., M.Ed., St. Boniface General Hospital, Z-3031, 409 Tache Ave, Winnipeg, Manitoba, Canada R2H 2A6. E-mail: jpark@sbgh.mb.ca

© 2014 The American Society of Colon and Rectal Surgeons