Patient perspective on pre-operative communication; a post-operative cross-sectional survey of patients with gastro-intestinal malignancy


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Samuel Lawday, Neil Smart, Jane Blazeby, Angus McNair

Abstract

Background

Undergoing major cancer surgery is an important decision for patients. This study assessed the effectiveness of decision-making following colorectal and oesophageal cancer surgery.

Method

Patients who had undergone colorectal and oesophageal cancer surgery in two UK centres over two years were identified. Validated patient reported outcomes (PROs) were collected by cross sectional survey including perceived confidence in decision-making and effectiveness of risk communication (COMRADE scale), decision regret (Decisional Conflict Score; DCS), and quality of life (EORTC QLQ-PAL15). Uni- and multivariable linear regression was used to explore the relationship between PRO scores and clinical and sociodemographic variables.

Results

Some 143/244 (58%) patients returned the questionnaire. Overall, decision regret was low (median 7.81, range 0-23.4), and perceived confidence in decision-making and effectiveness of risk communication was good (median 95 (75-100) and 85 (75-100) respectively).  Higher education level was associated with reduced regret  (-0.7; CI -1.2 to -0.1;p=0.016) and a longer length of hospital stay was associated with higher regret (1;CI 0.2-1.9;p=0.014 respectively).

Conclusion

Patients perceived decision-making to be effective in this study, but those with adverse outcomes may benefit from further support

Impact statement

This study identified, primarily, that patient who had undergone surgical management for their oesophageal and colorectal cancer had low decisional conflict regarding their choice to undergo surgery and felt as though the risks and benefits had been adequately commmunicated to them