CN5 Shared decision making in rectal cancer surgery: The way to go?

In rectal cancer surgery, there are two surgical options: A low anterior resection with preservation of the anal sphincter and an abdominoperineal resection with resection of the sphincter and formation of a permanent stoma. When the sphincter is not compromised, both surgical options are, from an oncological point of view, comparable. Given the need to take patients’ perspective into account, the choice of rectal cancer surgery is a value-based choice. To facilitate this, there is a growing interest in the use of decision aids. It helps patients to participate in weighing the impact of different treatment options on their QoL. The aim of this study was to explore the expectations of healthcare professionals (HCPs) and to evaluate the impact of using a decision aid in daily practice. A multi-centre explorative study was conducted. Individual semi-structured interviews with 16 interprofessional HCPs responsible for the care of patients with rectal cancer were performed. Thematic analysis was used during data-analysis and investigators’ triangulation was applied during analysis. First, HCPs felt that a decision aid would enable them to provide information in a more neutral and uniform way. Second, it was believed that the decision aid enhanced the understanding of the different aspects of QoL. Moreover, a shared decision was hypothesised to enable patients to accept consequences of rectal cancer surgery, such as bowel problems or a stoma. Additionally, it was believed to empowering patients and increasing their involvement in the treatment decision. Finally, some key issues for implementation were highlighted, such as reorganising the preoperative consultation, a consensus on the most appropriate moment to use the decision aid and the need for training. Several HCPs mentioned the added value of a nurse-led consultation, complementary to the physician. Using a decision aid to facilitate preoperative consultations was an added value according to HCPs. Before implementation, several key issues need to be taken into account. A nurse-led consultation could be an added value to facilitate shared decision making. A follow-up study will explore the impact on patients.