Context: Rectal cancer treatment decisions involve tradeoffs between outcomes like living with a permanent stoma versus long-term bowel dysfunction. The needs of rectal cancer patients and practitioners to partake in shared decision making are unknown. For such a complex decision, a patient decision aid that prepares patients to make informed, values-based decisions is warranted. Methods: 1) A systematic review, to characterize the prevalence of long-term dysfunction 2) Needs assessments, conducted with rectal cancer patients and practitioners, 3) Development of a decision aid. Results: 1) Significant variability exists in reporting rectal cancer outcomes. The rate of bowel dysfunction is high. 2) Rectal cancer patients recall little of the outcomes discussed preoperatively. They do not perceive having any surgical options. Practitioners are inconsistently engaging patients in shared decision-making. 3) A patient decision aid was developed that a) incorporated systematic review results and; b) addressed the needs, barriers and facilitators raised. Conclusions: Shared decision-making in rectal cancer surgery is limited. A decision aid to improve patient decision-making was developed.

Context: Rectal cancer treatment decisions involve tradeoffs between outcomes like living with a permanent stoma versus long-term bowel dysfunction. The needs of rectal cancer patients and practitioners to partake in shared decision making are unknown. For such a complex decision, a patient decision aid that prepares patients to make informed, values-based decisions is warranted. Methods: 1) A systematic review, to characterize the prevalence of long-term dysfunction 2) Needs assessments, conducted with rectal cancer patients and practitioners, 3) Development of a decision aid. Results: 1) Significant variability exists in reporting rectal cancer outcomes. The rate of bowel dysfunction is high. 2) Rectal cancer patients recall little of the outcomes discussed preoperatively. They do not perceive having any surgical options. Practitioners are inconsistently engaging patients in shared decision-making. 3) A patient decision aid was developed that a) incorporated systematic review results and; b) addressed the needs, barriers and facilitators raised. Conclusions: Shared decision-making in rectal cancer surgery is limited. A decision aid to improve patient decision-making was developed.

Context: Rectal cancer treatment decisions involve tradeoffs between outcomes like living with a permanent stoma versus long-term bowel dysfunction. The needs of rectal cancer patients and practitioners to partake in shared decision making are unknown. For such a complex decision, a patient decision aid that prepares patients to make informed, values-based decisions is warranted. Methods: 1) A systematic review, to characterize the prevalence of long-term dysfunction 2) Needs assessments, conducted with rectal cancer patients and practitioners, 3) Development of a decision aid. Results: 1) Significant variability exists in reporting rectal cancer outcomes. The rate of bowel dysfunction is high. 2) Rectal cancer patients recall little of the outcomes discussed preoperatively. They do not perceive having any surgical options. Practitioners are inconsistently engaging patients in shared decision-making. 3) A patient decision aid was developed that a) incorporated systematic review results and; b) addressed the needs, barriers and facilitators raised. Conclusions: Shared decision-making in rectal cancer surgery is limited. A decision aid to improve patient decision-making was developed.

Context: Rectal cancer treatment decisions involve tradeoffs between outcomes like living with a permanent stoma versus long-term bowel dysfunction. The needs of rectal cancer patients and practitioners to partake in shared decision making are unknown. For such a complex decision, a patient decision aid that prepares patients to make informed, values-based decisions is warranted. Methods: 1) A systematic review, to characterize the prevalence of long-term dysfunction 2) Needs assessments, conducted with rectal cancer patients and practitioners, 3) Development of a decision aid. Results: 1) Significant variability exists in reporting rectal cancer outcomes. The rate of bowel dysfunction is high. 2) Rectal cancer patients recall little of the outcomes discussed preoperatively. They do not perceive having any surgical options. Practitioners are inconsistently engaging patients in shared decision-making. 3) A patient decision aid was developed that a) incorporated systematic review results and; b) addressed the needs, barriers and facilitators raised. Conclusions: Shared decision-making in rectal cancer surgery is limited. A decision aid to improve patient decision-making was developed.

A rectal cancer patient decision aid (PtDA) was developed to help patients consider the benefits and risks associated with two surgical treatment options. The current thesis evaluated the effect of the PtDA on patients and explored surgeons’ perceived factors influencing the implementation of the PtDA in clinical practice. Using a before and after study design, the PtDA was given to patients with rectal cancer at a cancer assessment center. Based on 28 patients recruited, the PtDA improved their knowledge, lowered decisional conflict, and patients rated it acceptable. A cross-sectional survey was mailed to 105 Canadian colorectal surgeons and 49 responded (46.7% response rate). Commonly perceived barriers were time constraint, need for multiple visits, and additional personnel and facilitators were simplifying the decision aid, adding to content, and translating to other languages. The PtDA improved patient decision making outcomes but requires interventions to overcome surgeon-identified barriers to use in clinical practice.

No description available.

Purpose: The purpose of this thesis was threefold: 1) To explore the use of text-search methods for identifying rectal cancer patients in large datasets; 2) To examine temporal trends of surgical quality indicators for rectal cancer at a single, tertiary-care institution; 3) To validate the use of administrative codes for identifying rectal cancer patients in population-based datasets. Methods: 1) A text-search algorithm was developed, validated, and applied to all pathology reports at The Ottawa Hospital (TOH) over a 15-year period. Positive records were confirmed through manual chart review, and a gold-standard cohort of all rectal cancer resections performed at TOH was created. 2) Univariate and multivariate analyses were performed to assess temporal trends and associated factors for four (4) key surgical quality indicators. 3) Previously published methods for identifying rectal cancer resections in population-based datasets were validated using the cohort of patients created in Objective 1 as a gold standard. Results: 1) The text-search algorithm had a sensitivity and specificity of 100% and 98.4%, respectively. Because of low disease prevalence, positive predictive value (PPV) was 18.6%. 2) The proportion of resections with successful lymph node retrieval improved significantly over the course of the study period. No change was demonstrated for the remaining 3 surgical quality indicators. 3) Previously described methods that utilize procedure codes to identify rectal cancer resections in large administrative datasets had a sensitivity and specificity of 89.5% and 99.9%, respectively, with a PPV of 64.9%. Conclusions: It is feasible to utilize both procedure codes and text-search methods to identify patients with surgical resections for rectal cancer in administrative datasets. However, these methods are at risk of being inaccurate and resulting cohorts should be validated. Creating large cohorts of rectal cancer patients can be useful for studying a variety of subjects, including surgical quality.

No description available.

No description available.

Background Parastomal hernia is a common stoma complication causing the patient considerable inconvenience. The patient becomes aware of a bulge around the stoma, but a bulge is not always a parastomal hernia and diagnostics must be performed to enable differential treatment. It is difficult to distinguish between a bulge and a hernia. Results based on clinical examination and computerised tomography (CT) in the supine position, have not been convincing. Three-dimensional intrastomal ultrasonography (3D US) is a novel technique shown to be promising in the assessment of stoma complaints. Two studies were performed to determine inter- and intra-observer reliability as well as the validity of 3D US as an alternative to CT when assessing stoma complaints. There are numerous options for the treatment of parastomal hernia, but none has been shown superior. In the recent decades the use of mesh in the repair of incisional and inguinal hernia has become routine. New materials must be evaluated as there are potential morbidity and even mortality risks with mesh repair. As recurrence of a parastomal hernia is an even greater challenge, the method of choice should have a low risk for recurrence. A prospective multicenter study was performed to evaluate safety and recurrence rate when using Parastomal Hernia Patch BARDTM (PHP), a mesh specially designed for parastomal hernia repair. A stoma has a profound impact on the patient´s daily life, both physical and psychological. A parastomal hernia with its associated risk for leakage and incarceration worsens the situation. Patient driven assessment of healthcare outcome is important if we are to improve medical care. A quality of life (QoL) survey was performed to assess the impact of parastomal bulging and hernia on the patient´s daily life. Methods Forty patients were investigated and the 3D US images were twice evaluated by two or three physicians to assess inter- and intra-observer reliability. Totally 20 patients with stoma complaints requiring surgery were examined with CT and 3D US prior to surgery. The findings were compared with the intraoperative findings – regarded as the true outcome. Fifty patients with parastomal hernia requiring surgery were enrolled from three hospitals. Patients were followed up one month and one year after repair using PHP. Patients still alive in 2008 who had been operated between1996 and 2004 for rectal cancer in Uppsala/Örebro-, Stockholm/Gotland-, and Northern Regions (986 patients) and registered in the Swedish Rectal Cancer Registry (SRCR) were invited to fill in four QoL questionnaires. Results Inter-observer agreement using 3D US reached 80% for the last 10 patients examined, with a kappa value of 0.70. Intra-observer agreement for two examiners was 80% and 95%. The learning curve levelled out at 30 patients. Both CT and 3D US showed high sensitivity and specificity when compared with intraoperative findings. After surgery for parastomal hernia with a PHP, the complication rate at one month was 30% and recurrence rate at one year was 22%. Twelve patients were reoperated within one year. In the QoL study, 31.5% of the patients with a stoma reported a bulging or a hernia. 11.7% had been operated for parastomal hernia. A hernia or a bulge gave rise to significantly more pain and impaired stoma function. Overall QoL was inferior in patients with a permanent stoma compared to a group without a stoma.