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DOI: 10.1055/a-2771-7784
Exploring the Patient Voice in Decisions Around Organ-Preserving Rectal Cancer Treatment
Authors
Abstract
The patient's decision to pursue organ-sparing treatment for rectal cancer is nuanced and profoundly personal. As organ-sparing approaches like Watch-and-Wait become more widely adopted, it is increasingly important to understand how patients experience and navigate these complex decisions. Patients and providers may weigh treatment outcomes differently, reflecting varied priorities around survival, bowel function, and quality of life. This commentary draws on patient quotes to explore three key stages of decision-making: learning about treatment options, aligning values with choices, and coping with the aftermath of the decision. We highlight that patients often need tailored communication and educational resources to support understanding, that for some, avoiding an ostomy carries as much weight as oncologic outcomes like recurrence and survival, and that coping with intensive surveillance after treatment involves both emotional and logistical challenges that require ongoing support. These reflections underscore the need for accessible, patient-centered educational resources, communication strategies, and decision-support tools as organ-sparing treatments for rectal cancer become more widely implemented.
Keywords
rectal cancer - organ-sparing treatment - patient perspective - patient-centered care - shared decision-makingPublication History
Article published online:
16 January 2026
© 2026. Thieme. All rights reserved.
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References
- 1 Matsuyama RK, Kuhn LA, Molisani A, Wilson-Genderson MC. Cancer patients' information needs the first nine months after diagnosis. Patient Educ Couns 2013; 90 (01) 96-102
- 2 O'Connor G, Coates V, O'Neill S. Exploring the information needs of patients with cancer of the rectum. Eur J Oncol Nurs 2010; 14 (04) 271-277
- 3 Fletcher C, Flight I, Chapman J, Fennell K, Wilson C. The information needs of adult cancer survivors across the cancer continuum: a scoping review. Patient Educ Couns 2017; 100 (03) 383-410
- 4 Rivard SJ, Vitous CA, Bamdad MC. et al. “I wish there had been resources”: a photo-elicitation study of rectal cancer survivorship care needs. Ann Surg Oncol 2023; 30 (06) 3530-3537
- 5 Hu J, Zhang X, Sun J. et al. Supportive care needs of patients with temporary ostomy in enhanced recovery after surgery: a mixed-methods study. J Nurs Res 2024; 32 (03) e329
- 6 Smits LJH, van Lieshout AS, Debets S. et al. Patients' perspectives and the perceptions of healthcare providers in the treatment of early rectal cancer; a qualitative study. BMC Cancer 2023; 23 (01) 1266
- 7 Stacey D, Légaré F, Boland L. et al. 20th Anniversary Ottawa Decision Support Framework: part 3 overview of systematic reviews and updated framework. Med Decis Making 2020; 40 (03) 379-398
- 8 Elwyn G, Frosch D, Thomson R. et al. Shared decision making: a model for clinical practice. J Gen Intern Med 2012; 27 (10) 1361-1367
- 9 Blödt S, Kaiser M, Adam Y. et al. Understanding the role of health information in patients' experiences: secondary analysis of qualitative narrative interviews with people diagnosed with cancer in Germany. BMJ Open 2018; 8 (03) e019576
- 10 Abelson JS, Chait A, Shen MJ, Charlson M, Dickerman A, Yeo HL. Sources of distress among patients undergoing surgery for colorectal cancer: a qualitative study. J Surg Res 2018; 226: 140-149
- 11 Cuijpers ACM, Lubbers T, van Rens HA. et al. The patient perspective on the preoperative colorectal cancer care pathway and preparedness for surgery and postoperative recovery-a qualitative interview study. J Surg Oncol 2022; 126 (03) 544-554
- 12 Goldwag JL, Saunders CH, Read JT, Durand MA, Elwyn G, Ivatury SJ. A rectal cancer surgical decision aid is not enough: a qualitative study. Dis Colon Rectum 2022; 65 (12) 1483-1493
- 13 Saunders CH, Goldwag JL, Read JT, Durand MA, Elwyn G, Ivatury SJ. ‘Because everybody is so different’: a qualitative analysis of the lived experiences and information needs of rectal cancer survivors. BMJ Open 2021; 11 (05) e043245
- 14 Huang GJ, Penson DF. Internet health resources and the cancer patient. Cancer Invest 2008; 26 (02) 202-207
- 15 Kang R, Saunders CH, Carpenter-Song EA. et al. A mixed-methods evaluation of patient education materials for colorectal cancer. Dis Colon Rectum 2021; 64 (10) 1249-1258
- 16 Williams A, Cunningham A, Hutchings H, Harris DA, Evans MD, Harji D. Quality of internet information to aid patient decision making in locally advanced and recurrent rectal cancer. Surgeon 2022; 20 (06) e382-e391
- 17 Beas R, Cabanillas-Ramirez C, Izquierdo-Veraza D. et al. How good is online information for patients on the treatment for luminal gastrointestinal cancers? A comprehensive evaluation in English and Spanish. J Cancer Educ 2023; 38 (06) 1801-1807
- 18 Jacobson CE, Suwanabol PA. Readability of patient education materials from the American Society of Colon and Rectal Surgeons Website: an opportunity to improve health care access and quality. Dis Colon Rectum 2023; 66 (07) 865-868
- 19 Tucker CA. Promoting personal health literacy through readability, understandability, and actionability of online patient education materials. J Am Heart Assoc 2024; 13 (08) e033916
- 20 Holden CE, Wheelwright S, Harle A, Wagland R. The role of health literacy in cancer care: A mixed studies systematic review. PLoS One 2021; 16 (11) e0259815
- 21 Rothermel LD, Conley CC, Sarode AL. et al. Health literacy in surgical oncology patients: an observational study at a comprehensive cancer center. J Natl Compr Canc Netw 2021; 19 (12) 1407-1414
- 22 Scheer AS, O'Connor AM, Chan BP. et al. The myth of informed consent in rectal cancer surgery: what do patients retain?. Dis Colon Rectum 2012; 55 (09) 970-975
- 23 Gani C, Gani N, Zschaeck S. et al. Organ preservation in rectal cancer: the patients' perspective. Front Oncol 2019; 9: 318
- 24 Boss EF, Mehta N, Nagarajan N. et al. Shared decision making and choice for elective surgical care: a systematic review. Otolaryngol Head Neck Surg 2016; 154 (03) 405-420
- 25 Montori VM, Ruissen MM, Hargraves IG, Brito JP, Kunneman M. Shared decision-making as a method of care. BMJ Evid Based Med 2023; 28 (04) 213-217
- 26 Kruser JM, Nabozny MJ, Steffens NM. et al. “Best case/worst case”: qualitative evaluation of a novel communication tool for difficult in-the-moment surgical decisions. J Am Geriatr Soc 2015; 63 (09) 1805-1811
- 27 Holdsworth LM, Zionts D, Asch SM, Winget M. “Along for the ride”: a qualitative study exploring patient and caregiver perceptions of decision making in cancer care. MDM Policy Pract 2020; 5 (01) 2381468320933576
- 28 Hawley ST, Jagsi R. Shared decision making in cancer care: does one size fit all?. JAMA Oncol 2015; 1 (01) 58-59
- 29 Kehl KL, Landrum MB, Arora NK. et al. Association of actual and preferred decision roles with patient-reported quality of care: shared decision making in cancer care. JAMA Oncol 2015; 1 (01) 50-58
- 30 Byun HK, Koom WS. A practical review of watch-and-wait approach in rectal cancer. Radiat Oncol J 2023; 41 (01) 4-11
- 31 Derry-Vick HM, Heathcote LC, Glesby N. et al. Scanxiety among adults with cancer: a scoping review to guide research and interventions. Cancers (Basel) 2023; 15 (05) 1381
- 32 Mannion S, Martin NA, O'Connor J, Wieland J, Jatoi A. In their own words, “waiting sucks:” a qualitative study of medical testing-related anxiety in patients with cancer. Am J Hosp Palliat Care 2023; 40 (05) 468-474
