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Thesis (doctoral)--Ludwig Maximilians-Universität zu München, 1979.

Intact rectal sensation is integral to normal anorectal function. Rectal hyposensitivity (RH) implies diminished rectal sensory perception and is currently diagnosed using standard anorectal physiology tests. There is currently a lack of understanding regarding the nature and severity of symptoms, and pathophysiological mechasnisms by which RH leads to symptoms of constipation. Symptom severity and physiological abnormalities (potential pathophysiological mechanisms) were studied in patients with RH referred to a tertiary centre for evaluation of their symptom of intractable constipation. A pilot study using a novel technique to study recto-anal and recto-rectal reflexes in health and in patients with RH is also presented. RH was not associated with more severe symptoms as assessed using a standard constipation severity questionnaire. RH is more commonly associated with rectal evacuatory dysfunction (functional type). RH is also associated with a specific pattern of transit delay, where there is more hold up of the isotope in the left colon and this is independent of rectal evacuatory dysfunction. Afferent dysfunction in the majority of patients with rectal hyposensitivity relates purely to visceral pathways. However, a combined viscero-somatic pelvic sensory neuropathy is present in a proportion of patients. Similarly, a combined sensori-motor dysfunction was also seen in a subgroup of patients. Patients with RH have abnormal sampling and rectal contractile response to distension and this may play an important role in the pathophysiology of symptoms. The level of interruption of afferent pathway is likely to be heterogenous in patients with RH and constipation. Patients with RH display distinct physiological abnormalities that may be important to identify to tailor management. Whether, this leads to improved clinical outcomes needs to be further evaluated.

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.

Reproduction de : Thèse d'exercice : Médecine : Nancy 1 : 2003. / Titre provenant de l'écran-titre.

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.

Thesis (M.Sc.). / Written for the Medical Physics Unit. Title from title page of PDF (viewed 2008/07/30). Includes bibliographical references.