Development of a Patient Decision Aid for Rectal Cancer Patients with Clinical Complete Response after Neo-Adjuvant Treatment

SIMPLE SUMMARY: Rectal cancer patients with a clinical complete response (cCR) after neo-adjuvant treatment may be spared the surgical morbidity and mortality of radical surgery without oncological compromise. Therefore, discussing treatment options, including organ-sparing strategies (watch-and-wait) as an oncological equivalent alternative to major surgery, is important in the shared decision making (SDM). SDM may be facilitated by a patient decision aid (PtDA). The aim of this study was to develop and evaluate a PtDA for rectal cancer patients who have a cCR after neo-adjuvant treatment. ABSTRACT: Surgery is the primary component of curative treatment for patients with rectal cancer. However, patients with a clinical complete response (cCR) after neo-adjuvant treatment may avoid the morbidity and mortality of radical surgery. An organ-sparing strategy could be an oncological equivalent alternative. Therefore, shared decision making between the patient and the healthcare professional (HCP) should take place. This can be facilitated by a patient decision aid (PtDA). In this study, we developed a PtDA based on a literature review and the key elements of the Ottawa Decision Support Framework. Additionally, a qualitative study was performed to review and evaluate the PtDA by both HCPs and former rectal cancer patients by a Delphi procedure and semi-structured interviews, respectively. A strong consensus was reached after the first round (I-CVI 0.85-1). Eleven patients were interviewed and most of them indicated that using a PtDA in clinical practice would be of added value in the decision making. Patients indicated that their decisional needs are centered on the impact of side effects on their quality of life and the outcome of the different options. The PtDA was modified taking into account the remarks of patients and HCPs and a second Delphi round was held. The second round again showed a strong consensus (I-CVI 0.87-1).