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Session: ePoster: Rectal Cancer 12 (Sat315)

EP176 - Nurse-led Screening and Education Program for Self-Management of LARS Improves Rectal Cancer Patients’ Self-Reported Confidence: Quality Improvement Initiative

Saturday, May 10, 2025
3:47 PM – 3:52 PM PT
Location: Monitor 10, Sails Pavilion, Upper Level

    ePoster Presenter(s)

  • Claudia L. DiVenti, RN, BSN, MSN, DNP (she/her/hers)

    Nurse Research Coordinator
    Cleveland Clinic Florida
    Fort Lauderdale, FL, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Author(s)

  • SS

    Sarah Sabboobeh, MSc

    Research Associate
    Jewish General Hospital
    Montreal, Quebec, Canada

    Disclosure information not submitted.

  • JR

    Judith Rogers-Fruiterman, PhD, MSN, BSN

    Interim Department Director, The Malek School of Nursing Professions
    Malek School for Health Professions, Marymount University
    Leesburg, Virginia, United States

    Disclosure information not submitted.

  • MM

    Maureen Moriarty, DNP, MSN, BSN

    Associate Professor, Associate Director of Graduate Education
    Malek School for Health Professions, Marymount University
    Arlington, Virginia, United States

    Disclosure information not submitted.

  • GD

    Giovanna DaSilva, MD

    Colorectal Surgeon
    Cleveland Clinic Florida

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

  • David Maron, MD

    Surgeon
    Cleveland Clinic Florida
    Weston, Florida, United States

    Disclosure information not submitted.

  • Eric Weiss, MD, MD

    Colorectal surgeon
    Cleveland Clinic Florida
    Weston, Florida, United States

    Disclosure information not submitted.

  • ES

    Ebram Salama, MD

    Surgeon
    Cleveland Clinic Florida
    Weston, Florida, United States

    Disclosure information not submitted.

  • Zoe Garoufalia, MD (she/her/hers)

    Colorectal Surgery Fellow
    Cleveland Clinic Florida
    Cleveland Clinic Florida
    Weston, FL, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

  • Steven D. Wexner, MD, PhD (Hon), MD, PhD (Hon), FACS, FRCS, FRCSI, MAMSE

    Emeritus Chair, Department of Colorectal Surgery
    Cleveland Clinic Florida
    Cleveland Clinic Lerner College of Medicine at Case Western Reserve University
    Weston, Florida, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no relevant relationships with ineligible companies.

    • Senior Author(s)

  • Marylise Boutros, MD (she/her/hers)

    Colorectal Surgeon
    Cleveland Clinic Florida
    McGill University
    Weston, Florida, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no relevant relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.
Claudia L. DiVenti, DNP, MSN, BSN, RN: This individual has no financial relationships with ineligible companies.
Giovanna DaSilva, MD: This individual has no financial relationships with ineligible companies.
Zoe Garoufalia, MD: This individual has no financial relationships with ineligible companies.
Steven D. Wexner, MD, PhD (Hon), FACS, FRCS, FRCSI, MAMSE, MD, PhD (Hon): This individual has no relevant relationships with ineligible companies.
Marylise Boutros, MD: This individual has no relevant relationships with ineligible companies.
Image or Table (Do Not add text here):

Purpose/Background: Low Anterior Resection Syndrome (LARS) is a debilitating bowel dysfunction impacting most rectal cancer patients who undergo low anterior resection. Symptoms vary due to patient-dependent factors, making a one-size-fits-all algorithm ineffective. The cornerstone of LARS treatment is self-management with conservative measures but most patients are left without guidance on how to achieve this successfully. We recently completed a randomized controlled trial demonstrating feasibility and success with a nurse-led LARS management program. This quality improvement initiative aimed to assess real-life acceptance of a nurse-led screening and education program focused on improving patients’ self-confidence in managing LARS symptoms.

Methods/Interventions: This nurse-led screening and education program was developed and implemented as a QI initiative from March 2024-August 2024 in a single-institution tertiary referral center. The program involved screening rectal cancer patients at any point in their rectal cancer journey using the LARS score to identify problem symptoms. Identified symptoms were addressed during one-on-one education sessions by a trained LARS nurse. Education was supplemented with a booklet designed by a multidisciplinary team. Patients were instructed to practice the discussed self-management strategies for 2 weeks, after which a second encounter with the nurse reinforced and troubleshot self-management strategies. Patients completed an anonymous evaluation of the program after follow-up using an 8 item (4-point Likert-scale) investigator-created survey with a section for free text comments, which were coded by two reviewers according to themes.

Results/Outcomes: All 30 patients referred to the program agreed to participate. Median age was 62 (IQR 13.3) years and 57% were female. 70% of participants were in survivorship (median time 1.75 (IQR 2) years), 14% were pretreatment and 16% were in treatment. For post-LARS participants, 75% had major and 15% had minor LARS. Symptom screening using the LARS score revealed that 88% of participants experienced fecal incontinence including clustering (84%), flatus incontinence (80%), urgency (80%), and frequency (72%). Without prompting, 37% reported other symptoms not covered in the current LARS score: tenesmus, rectal spasms, painful anal skin, constipation, bloating, anxiety, depression, poor self-image, sleep deprivation, and sexual dysfunction. Unmet needs reported included nutrition counselling, support groups, preoperative LARS education, post-treatment LARS counseling, and reliable resources including useful websites, social media groups, and mobile applications. In the program, counselling consisted of education on social strategies, dietary changes, bulking agents, anti-diarrheals, laxatives, anal skin care, transanal irrigation, toileting habits, and pelvic floor exercises. After the follow-up visit, participants reported feeling more confident in their ability to manage their symptoms including bowel incontinence (88%), urgency and clustering (86%), frequency (83%), and 75% flatulence incontinence (75%). All patients found in-person education by the nurse useful (89% strongly agree) and the educational booklet useful.

Conclusion/Discussion: Implementation of a nurse-led LARS screening and education program was highly accepted by rectal cancer patients and improved their self-reported confidence in LARS self-management. Future work will include more screening tools, interventions and a longer program duration.