Interprofessional perspectives on care for patients with low anterior resection syndrome: A qualitative study

Abstract

Aim Many patients are confronted with low anterior resection syndrome after rectal surgery. The perspectives of both healthcare professionals and patients on the impact of bowel problems may differ. This study aimed to explore experiences of healthcare professionals on how to provide, organise and optimise care for patients with low anterior resection syndrome from an interprofessional perspective. Methods An explorative qualitative design was used. Healthcare professionals were recruited in October 2018 in one general teaching hospital and one university hospital. Twenty one healthcare professionals from different professions caring for patients with low anterior resection syndrome were included in three focus group interviews. Results Healthcare professionals confirmed a lack of focus on patients who are confronted with low anterior resection syndrome and stated a need for a standardised approach of care. Additionally, three levels for care optimization emerged from the data: information before surgery with strong emphasis on the timing of informing, counselling of patients when confronted with low anterior resection syndrome and organisation of care. Conclusions Healthcare professionals find it important to adopt the moment and amount of information to the coping mechanism and timing of the trajectory. Counselling and follow‐up of patients with LARS should be organised proactively and should not remain restricted to pharmacological and nutritional advice. A possible strategy is to develop and implement late effects nurse‐led clinics coordinated by the clinical nurse specialist.

‘He's a surgeon, like I'm not going to waste his time’: interviews to determine healthcare needs of people with low anterior resection syndrome after rectal cancer surgery

“…Within the final theme participants discussed often unmet healthcare needs. They also reported a similarity of need, correlating with those reported in other studies [19], for example a perceived lack of guidance, as identified by Pape et al [20].…”

“…this could potentially be clarified during subsequent clinical discussions. Furthermore, participants need clinicians to acknowledge that symptoms exist and offer a LARS diagnosis, as has been previously reported [20]. Additionally, participants need clinicians to understand LARS symptoms, also reported by Chen et al [9].…”

“…Information additional to clinician-led conversation enabled participants to review it when ready, preventing overload. Pape et al [20] reported that clinicians recognize the risk of information overload, which may account for the withholding of information; however, participants want information. Participants desire information on management options, including diet, but despite NICE guidelines [18] recommending dietetic input, only a quarter of hospitals have colorectal dietetic outpatient follow-up [24].…”

Care of Post-Operative Altered Bowel Function in Colorectal Cancer Patients

“…Although management of low anterior resection syndrome remains equivocal, some strategies are mentioned [5,[29][30][31][32][33][34]. The strategies involve in three options: self-care strategies, clinician-initiated interventions, and creating a permanent stoma [29][30][31]35].…”

Will a better‐informed patient take ‘the right’ decision?

“…A possible way on how the care of LARS patients can be organized is another piece of the puzzle and is studied by Pape et al [6] in this issue of Colorectal Disease . The authors investigated interprofessional perspectives on care for LARS patients.…”