Bowel symptom management following sphincter-sparing surgery for rectal cancer

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O'Sullivan, Mairéad
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University College Cork
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Aims: The aim of this study is to determine the content, format and mode of delivery of an intervention for patients following sphincter-sparing surgery who have experienced altered bowel function. Background: The treatment of rectal cancer often causes the development of life-altering bowel symptoms. Healthcare professionals play a pivotal role in supporting patients in their management of symptoms but increasingly it is recognised that care often becomes the patients’ sole responsibility. Numerous studies have identified the need to support patients in the self-care of their bowel symptoms and to develop interventions to facilitate same. Yet there is a dearth of literature around interventions to support patients with the symptoms specific to rectal cancer treatment, to self-care for their bowel symptoms, which do not involve the use of invasive techniques or continuous health-care professional input. Design: A qualitative descriptive design. Methods: To determine the content, format and mode of delivery of an intervention a purposeful sample of five patients and ten healthcare professionals were interviewed through individual semi-structured, audio-recorded interviews. Participants included those who had undergone sphincter-sparing surgery for rectal cancer and those involved in their care. An initial pilot study was carried out prior to conducting the main study. Data were analysed utilising deductive content analysis and data coded according to pre-determined categories. The research was underpinned by the Symptom Management Theory and also utilised the Medical Research Council Framework Guidance for the Development of Complex Interventions. Findings: Participants acknowledged the existence and impact of bowel dysfunction following surgery for rectal cancer, often continuing for a number of years post-treatment and varying from frequency, urgency and tenesmus to skin irritation and pain, in addition data analysis revealed multiple symptoms which occurred and in addition the variability of these symptoms in relation to severity, duration and associated degree of bother. The psychological and social impact of symptoms was also evident. All participants (n=15) acknowledged issues within the current practice around educating patients about the incidence, treatment and self-care of bowel symptoms, often resulting in prolonged periods of symptom experience or use of unhelpful or unsafe self-care strategies. Additionally, participants identified the need for the development of an intervention to support patients. Patients and healthcare professionals identified a phone application as a convenient and accessible method but also acknowledged the need for a booklet/written mode to cater for those less able to utilise technological formats. Of interest some healthcare professionals felt that a leaflet format would be preferable as a means of intervention delivery, this contrasted with the views of patients who felt an online or phone application format would allow greater accessibility and convenience. The intervention proposed is a multi-modal format which provided patients with information around medication, diet, skin care, resources, alternative therapies and pelvic floor exercises. Finally, throughout all interviews the need for a human contact, i.e. ability to access a healthcare professional, was highlighted as a pivotal and important feature of any intervention. Conclusion: This research has provided insights into the bowel symptoms experienced by patients following sphincter-sparing surgery for rectal cancer, the impact of these symptoms, the strategies utilised to manage these symptoms. Importantly, this study identified the need to create an intervention to allow patients to manage their symptoms in a safe and evidence-based manner and determined the appropriate content, format and mode of delivery using the findings of interviews with both affected patients and those involved in their care.
Colorectal , Bowel cancer , Rectal cancer , Bowel function , Bowel dysfunction , Intervention , Self-care strategies , Colorectal cancer , Urgency , Physical bowel symptoms , Social impact of bowel symptoms , Sphincter sparing surgery
O'Sullivan, M. 2019. Bowel symptom management following sphincter-sparing surgery for rectal cancer. MRes Thesis, University College Cork.
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