"So, what are you saying?": A qualitative study of surgeon-patient communication in the rectal cancer consultations.

Abstract

Introduction: Patients with rectal cancer face a potentially life-limiting disease with multi-modal treatment options conferring substantial symptom burdens. Treatment decisions frequently require trade-offs and input from a multidisciplinary team: ideal cases for shared decision-making. Using qualitative analysis, we characterized the content of communication between surgeons and patients who have rectal cancer.

Methods: We performed secondary analysis of audio-recorded clinic visits of patients with rectal cancer (n ​= ​18) with colorectal surgeons (n ​= ​8) at 5 academic centers. Four coders used inductive content analysis with an analytical emphasis on communication about decision-making.

Results: Surgeons focused on communicating technical details of potential treatment pathways. Patients sought information around prognosis, functional changes, long-term recovery, and next steps. Surgeons laid groundwork for shared decision-making; patient goals were not routinely clarified. Decisions were typically deferred due to uncertainty and missing information needed to determine appropriate treatment options.

Conclusions: Our findings suggest avenues for surgeons to enhance communication around rectal cancer decision-making: acknowledging uncertainty and providing concrete information when able, focusing on topics such as prognosis, tradeoffs, and long-term recovery, and clarifying patient preferences.