SS400 - What Patients Want: Shared Decision-Making for Locally Advanced Rectal Cancer

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Purpose/Background: There is debate over the role of watch and wait (WW) versus surgical resection for locally advanced rectal cancer (LARC). Given the variability in practice it is unclear whether shared decision (SDM) making occurs in this population. Understanding patients’ experience with SDM is crucial for supporting individualized treatment decisions.

Methods/Interventions: We conducted a qualitative study with semi-structured interviews of patients with LARC at a single tertiary medical center. Interviews explored patients’ experience with SDM, perceptions of treatment options, and factors influencing decision making. Thematic analysis was conducted using inductive and deductive approaches.

Results/Outcomes: 15 patients were interviewed. The average age was 60 years. 7 patients had a clinical complete response (cCR) and entered WW; 1 patient had cCR but chose surgery; 4 patients did not achieve a cCR and underwent surgery; 2 patients were currently undergoing total neoadjuvant therapy; and 1 patient had a recurrence after cCR. 4 themes emerged: 1) Satisfaction with early WW discussion: Patients learned about WW at various times and those introduced to WW earlier had an easier time processing their options. Some patients expressed frustration with learning about WW later in the treatment course 2) Information gaps: Many patients felt overwhelmed by the volume of information yet desired more details regarding risk of cancer recurrence, bowel function with and without surgery, and life with a temporary or permanent stoma. Patients sought peer support by speaking to others with rectal cancer or stomas and used online resources to aid in their decision. 3) Patient engagement in decision making: Despite being presented WW as an option, many patients felt that the focus of their care was on preparation for surgery. This emphasis left them uncertain about candidacy for WW. To bridge these gaps, patients developed numerous strategies to navigate the decision making process including bringing a care partner to appointments to enhance information retention, speaking to others with similar experiences, and referring to online sources. Additionally, patients expressed a strong desire for written materials to reference during the decision-making process. 4) Balancing anxiety with treatment recommendations: Anxiety played a role in decision-making as many expressed concerns about making the wrong choice and the uncertainty surrounding cancer recurrence.

Conclusion/Discussion: Patients’ experience with WW varies and the decision-making process is emotionally complex. Patients often rely on peer support to guide them through the process and express a need for more structured peer support networks and written materials. Additionally, ensuring that information on WW and surgery is clear, accessible, and appropriately timed is critical in helping patients feel comfortable with their decisions. Enhancing the clarity of WW discussion, offering detailed information on recurrence and outcomes, and providing peer support may improve overall patient satisfaction and decision-making confidence.