Decision making in pelvic exenteration for locally advanced and locally recurrent rectal cancer

Abstract

This thesis relates to locally advanced and locally recurrent rectal cancer (LARC and LRRC) and examines the decision-making process in patients contemplating potential surgical cure with pelvic exenteration (PE). It will determine the factors that influence the decision to undergo or to decline surgery for both patients and clinicians. The aim of this research is to produce a validated Patient Decision Aid (PtDA) for patients with LARC and LRRC to facilitate the shared decision making (SDM) process. Objectives1.To undertake a systematic literature review to identify existing validated PtDAs and grey literature including online forums for PE.2.To explore whether English patient information leaflets (PILs) exist at centres worldwide performing exenterative surgery.3.To explore through qualitative interviews patient views regarding what factors are important to them when making decisions regarding PE surgery.4.To explore through qualitative interviews with clinicians their views regarding what they perceive to be important for the patient to consider when making decisions regarding PE surgery.5.To use the findings from the literature review and qualitative interviews to inform the first stage development of a PtDA that outlines treatment options for patients with LARC or LRRC.6.To develop the PtDA using key stakeholders.7.To assess the content and face validity of the PtDA.8.To assess the reliability and validity of the PtDA.9.To assess the feasibility and efficacy of the PtDA