title: Preoperative risk information and patient involvement in surgical treatment for rectal and sigmoid cancer.
abstract: OBJECTIVE
  Surgery for rectal and sigmoid cancer is a model setting for investigating preoperative information provision and shared decision making (SDM), as the decision consists of a trade-off between the pros and cons of different treatment options. The aim of this study was to explore surgeons' opinion on the preoperative information that should be given to rectal and sigmoid cancer patients and to evaluate what is actually communicated. In addition, we assessed surgeons' attitudes towards SDM and compared these with patient involvement.
  
  
  METHODS
  A questionnaire was sent to Dutch surgeons with an interest in gastroenterology. Preoperative consultations were recorded. A checklist was used to code the information that surgeons communicated to the patients. The OPTION-scale was used to measure patient involvement.
  
  
  RESULTS
  Questionnaires were sent to 240 surgeons, and 103 (43%) responded. They stated that information on anastomotic leakage and its consequences, the benefits and risks of a defunctioning stoma and the impact of a stoma on quality of life were necessary preoperative information. In practice, patients were inconsistently informed of these items. Most participants agreed to using SDM in their consultations. However, in practice, most patients were offered only one treatment option and little SDM was seen. The mean OPTION-score was low (7/100).
  
  
  CONCLUSIONS
  Insufficient information is given to patients with rectal and sigmoid cancer to guide them on their preferred surgical option. Information should be given on all treatment options, together with their complications and outcome, before any decision is made.
authors.affiliation: Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands.
authors.forename: H S
authors.initials: HS
authors.lastname: Snijders
authors.forename: M
authors.initials: M
authors.lastname: Kunneman
authors.forename: B A
authors.initials: BA
authors.lastname: Bonsing
authors.forename: A C
authors.initials: AC
authors.lastname: de Vries
authors.forename: R A E M
authors.initials: RA
authors.lastname: Tollenaar
authors.forename: A H
authors.initials: AH
authors.lastname: Pieterse
authors.forename: A M
authors.initials: AM
authors.lastname: Stiggelbout
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak; D003107:Colorectal Surgery / Q000379:methods*; D003125:Colostomy; D003142:Communication; D003657:Decision Making; D005242:Fecal Incontinence; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010358:Patient Participation; D010817:Physician-Patient Relations; D057234:Preoperative Period; D012004:Rectal Neoplasms / Q000601:surgery*; D012017:Referral and Consultation; D012306:Risk; D012811:Sigmoid Neoplasms / Q000601:surgery*; D054047:Surgical Stomas; D011795:Surveys and Questionnaires
keywords: Risk information; colorectal cancer surgery; shared decision making