“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.