title: Patient expectations of functional outcomes after rectal cancer surgery: a qualitative study.
abstract: BACKGROUND
  Rectal cancer patients' expectations of health and function may affect their disease- and treatment-related experience, but how patients form expectations of postsurgery function has received little study.
  
  
  OBJECTIVE
  We used a qualitative approach to explore patient expectations of outcomes related to bowel function after sphincter-preserving surgery for rectal cancer.
  
  
  METHODS
  This was a cohort study of patients who were about to undergo sphincter-preserving surgery for rectal cancer.
  
  
  METHODS
  The study was conducted through individual telephone interviews with participants.
  
  
  METHODS
  Twenty-six patients (14 men and 12 women) with clinical TNM stage I to III disease were enrolled.
  
  
  METHODS
  The semistructured interview script contained open-ended questions on patient expectations of postoperative bowel function and its perceived impact on daily function and life. Two researchers analyzed the interview transcripts for emergent themes using a grounded theory approach.
  
  
  RESULTS
  Participant expectations of bowel function reflected 3 major themes: 1) information sources, 2) personal attitudes, and 3) expected outcomes. The expected outcomes theme contained references to specific symptoms and participants' descriptions of the certainty, importance, and imminence of expected outcomes. Despite multiple information sources and attempts at maintaining a positive personal attitude, participants expressed much uncertainty about their long-term bowel function. They were more focused on what they considered more important and imminent concerns about being cancer free and getting through surgery.
  
  
  CONCLUSIONS
  This study was limited by context in terms of the timing of interviews (relative to the treatment course). The transferability to other contexts requires further study.
  
  
  CONCLUSIONS
  Patient expectations of long-term functional outcomes cannot be considered outside of the overall context of the cancer experience and the relative importance and imminence of cancer- and treatment-related events. Recognizing the complexities of the expectation formation process offers opportunities to develop strategies to enhance patient education and appropriately manage expectations, attend to immediate and long-term concerns, and support patients through the treatment and recovery process.
authors.affiliation: 1Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada 2Department of Surgery, University of Wisconsin, Madison, Wisconsin 3Department of Health Policy and Management, University of North Carolina, Chapel Hill, North Carolina 4Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 5Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Jason
authors.initials: J
authors.lastname: Park
authors.forename: Heather B
authors.initials: HB
authors.lastname: Neuman
authors.forename: Antonia V
authors.initials: AV
authors.lastname: Bennett
authors.forename: Lily
authors.initials: L
authors.lastname: Polskin
authors.forename: P Terry
authors.initials: PT
authors.lastname: Phang
authors.forename: W Douglas
authors.initials: WD
authors.lastname: Wong
authors.forename: Larissa K
authors.initials: LK
authors.lastname: Temple
mesh_terms: D000328:Adult; D000368:Aged; D001290:Attitude; D015331:Cohort Studies; D003672:Defecation; D004644:Emotions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D020127:Recovery of Function; D012004:Rectal Neoplasms / Q000503:physiopathology / Q000523:psychology* / Q000601:surgery*; D013850:Thinking; D016896:Treatment Outcome; D035501:Uncertainty