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Clin Colon Rectal Surg
DOI: 10.1055/a-2760-7307
Review Article

Shared Decision-Making in the Surgical Management of Rectal Cancer: Comparing Low Anterior Resection and Abdominoperineal Resection Using a Patient Decision Aid

Authors

  • Kala Hickey

    1   Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
    2   Faculty of Medicine, The University of Ottawa, Ottawa, Ontario, Canada

  • Victoria Ivankovic

    1   Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
    2   Faculty of Medicine, The University of Ottawa, Ottawa, Ontario, Canada

  • Robin Boushey

    2   Faculty of Medicine, The University of Ottawa, Ottawa, Ontario, Canada
    3   Endoscopy Division, Ottawa Gastrointestinal Institute, Ottawa, Ontario, Canada
    4   Department of Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada

  • Sameer S. Apte

    1   Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
    2   Faculty of Medicine, The University of Ottawa, Ottawa, Ontario, Canada
    3   Endoscopy Division, Ottawa Gastrointestinal Institute, Ottawa, Ontario, Canada
    4   Department of Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Abstract

Low rectal cancer is surgically managed with one of two primary procedures: low anterior resection (LAR) or abdominoperineal resection (APR). Each procedure has a unique profile of potential complications, oncologic outcomes, and quality-of-life impacts. The acceptability of these outcomes is highly driven by patient values. Consequently, shared decision-making is essential to selecting the optimal procedure for each patient. Evidence has shown that patient decision aids (PtDAs) improve patient knowledge, reduce decisional conflict, and support value-congruent decisions. This review describes the development of a rectal cancer PtDA for the choice between LAR and APR. This PtDA was designed according to the International Patient Decision Aid Standards and Ottawa Decision Support Framework. Evaluation of this rectal cancer PtDA demonstrated increased patient knowledge, reduced decisional conflict, and enhanced patient preparedness for decision-making. Despite strong evidence for their utility, PtDAs remain underutilized. This review highlights key barriers in implementing PtDAs and proposes strategies to facilitate the effective integration of PtDAs into surgical practice.

Keywords

rectal cancer - shared decision-making - patient decision aid - low anterior resection - abdominoperineal resection


Publication History

Article published online:
23 December 2025

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