EP818 - Shared Decision-Making in the Non-Operative Management of Rectal Cancer: Is There Room for Improvement?

Monday, May 12, 2025

1:42 PM – 1:47 PM PT

ePoster Presenter(s)

Oluseye Oduyale, MD MPHS

General Surgery Resident
Washington University School of Medicine
Washington University School of Medicine in St. Louis
St. Louis, Missouri, United States

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

Author(s)

Racquel S. Gaetani, MD (she/her/hers)

General Surgery Resident/Colorectal Research Fellow
LAHEY HOSPITAL AND MEDICAL CENTER
Lahey Hospital and Medical Center
Burlington, MA, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
Ahmed A. Eltahir, MD MPHS

General Surgery Resident
Washington University School of Medicine
Washington University in St. Louis
St. Louis, MO, United States

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

Merrill Rubens, MD

Resident Physician
Washington University School of Medicine
St. Louis, Missouri, United States

Disclosure information not submitted.
RB

Rachel Bolognese, n/a

Medical Student
UMass Chan Medical School
Burlington, Massachusetts, United States

Disclosure information not submitted.
Matthew Mutch, MD

Professor of Surgery
Washington University
Washington University School of Medicine
St Louis, Missouri, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
Jonathan S. Abelson, MD MS (he/him/his)

Staff Surgeon
Lahey Hospital and Medical Center
Tufts Medical Center
Arlington, Massachusetts, United States

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

Senior Author(s)

WC

William C. Chapman, Jr., MD

Assistant Professor
Washington University School of Medicine
St. Louis, Missouri, United States

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

All of the relevant financial relationships listed below have been mitigated.

Oluseye Oduyale, MD MPHS: This individual has no financial relationships with ineligible companies.

Racquel S. Gaetani, MD: This individual has no financial relationships with ineligible companies.

Ahmed A. Eltahir, MD MPHS: This individual has no financial relationships with ineligible companies.

Matthew Mutch, MD: This individual has no financial relationships with ineligible companies.

Jonathan S. Abelson, MD MS: This individual has no financial relationships with ineligible companies.

William C. Chapman, MD, Jr.: This individual has no financial relationships with ineligible companies.

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Purpose/Background: Patients with locally advanced rectal cancer who undergo neoadjuvant therapy may be eligible for non-operative management (NOM) after achieving complete or near-complete clinical response (CCR/nCR). The decision to initiate NOM versus proctectomy is complex and requires patients and their providers together to consider implications regarding clinical outcomes, intensive surveillance and long-term quality of life. We sought to characterize this shared decision-making (SDM) process and identify predictors of high SDM among LARC patients who were eligible for NOM after neoadjuvant therapy.

Methods/Interventions: In this ongoing multi-institutional prospective study starting February 2024, we identified patients with LARC who completed neoadjuvant therapy and achieved CCR/nCR. Demographic data including social vulnerability index, patient level of education and annual income, treatment status, low anterior resection syndrome (LARS) score, control preferences scale, 9-item shared decision-making questionnaire (SDM-Q-9), and either the decision regret scale (DCS) or decision conflict scale (DRS) were prospectively collected. The SDM-Q-9 was scored out of 100, and we defined patients experiencing high SDM as those who scored >90. Univariate analyses were performed comparing patients with high SDM and low SDM.

Results/Outcomes: A total of 28 patients with completed questionnaires after CCR/nCR. The mean age was 60 years at the time of the questionnaire; 16 (55%) patients were men, and one patient was a racial/ethnic minority. Among them, one chose to undergo TME instead of NOM, and four had experienced local regrowth at the time of survey. The mean LARS score among all patients was 20.6 (SD 11.9), while the mean SDM-Q-9 score was 88.5 (SD 12.8). Sixteen patients had high SDM, while 12 had low SDM. A minority of patients experienced decisional conflict (42%) or decisional regret (19%). On univariate analysis, patients who experienced high SDM were more likely to have a college education compared to those with low SDM (75% vs 25%, Fisher’s exact p=0.020). Patients who experienced high SDM tended to earn high annual income (above $150,000) compared to those with low SDM, though this difference did not reach statistical significance (63% vs 33%, Fisher’s exact p=0.087). There were otherwise no differences in age, gender, LARS score or control preference between patients who experienced high vs low SDM.

Conclusion/Discussion: Overall, patients who were eligible to choose NOM versus proctectomy after neoadjuvant therapy experienced moderate levels of shared decision-making and little decisional regret or conflict. Shared decision-making, however, varied by markers of socioeconomic status like patient education and income level. Continued studies are needed to further identify markers of poor SDM. Interventions like patient decision aids may be needed to improve decision-making after CCR/nCR, particularly for those with lower levels of education.