QS120 - Clinician and Patient Stakeholders Prioritize Rectal Prolapse Research Themes Through an International Delphi Process

Image or Table (Do Not add text here):

Purpose/Background: There is limited understanding on how to focus research and resources for the acquisition of new knowledge to enhance care for individuals with rectal prolapse (RP). This study aimed to identify and prioritize clinical research themes for RP with and without pelvic organ prolapse based on the perspective of clinician and patient stakeholders.

Methods/Interventions: This IRB-approved (73560) study utilized the Delphi method (>70% consensus) with an initial open response survey to identify research themes followed by three subsequent iterative clinician survey rounds (CR1,CR2,CR3) collected via REDCap© to capture clinician responses. Surveys were distributed through the Pelvic Floor Consortium (PFC) volunteer list and champions from Brazil, Italy, Australia, UK and Asia advocated for participation through their local societies. The consensus meeting was held during the PFC, ASCRS Baltimore 2024 to discuss survey results and re-vote on themes that were just below the 70% consensus cutoff. The final statements reaching consensus were adapted into a patient survey for patients who self identified as having a current or a past history of rectal prolapse. Clinician and survey results were reviewed at the International Continence Society (ICS), Madrid 2024 as part of an PFC/ICS collaborative initiative. Clinicians who completed all three surveys are recognized as PFC author volunteers.

Results/Outcomes: Three hundred seventy-two clinicians completed CR1 and response rates were 69% and 64% for CR2 and CR3, respectively. The majority of respondents were colorectal surgeons (68%), Urogynecologist/Female Urologist (15%), and Pelvic Floor Physical Therapist (11%). 76% of clinician responders reported 10 or more years in practice and 72% had academic affiliations whereas 18% were in private practice. Clinician responders were from the US (50%), Europe (18%), Latin America (15%), Asia (8%) and Australia/New Zealand (6%). Forty-five themes were included in CR1, 19 themes reached consensus at the end of round three. One hundred forty-six clinicians attended the consensus meeting and 13 themes were reconsidered during the meeting, 3 of which reached consensus. The final consensus comprised 22 themes which were adapted into a patient survey. Nineteen women > 50 (50-90 years old) from the USA completed the patient survey. Ten themes reached consensus with all stakeholders (Table 1) with long-term functional outcomes reaching nearly unanimous agreement.

Conclusion/Discussion: Through an iterative process we have identified a list of themes that can guide outcomes research over the next decade. The pelvic floor consortium intends to focus clinician efforts, resources and funding on providing insight around long-term outcomes and prolapse recurrence. During the short-term, we aim to increase the number and diversity of patient responders through international collaboration.