title: Which benefits and harms of preoperative radiotherapy should be addressed? A Delphi consensus study among rectal cancer patients and radiation oncologists.
abstract: OBJECTIVE
  We previously found considerable variation in information provision on preoperative radiotherapy (PRT) in rectal cancer. Our aims were to reach consensus among patients and oncologists on which benefits/harms of PRT should be addressed during the consultation, and to assess congruence with daily clinical practice.
  
  
  METHODS
  A four-round Delphi-study was conducted with two expert panels: (1) 31 treated rectal cancer patients and (2) 35 radiation oncologists. Thirty-seven possible benefits/harms were shown. Participants indicated whether addressing the benefit/harm was (1) essential, (2) desired, (3) not necessary, or (4) to be avoided. Consensus was assumed when ⩾80% of the panel agreed. Results were compared to 81 audio-taped consultations.
  
  
  RESULTS
  The panels reached consensus that six topics should be addressed in all patients (local control, survival, long term altered defecation pattern and faecal incontinence, perineal wound healing problems, advice to avoid pregnancy), three in male patients (erectile dysfunction, ejaculation disorder, infertility), and four in female patients (vaginal dryness, pain during intercourse, menopause, infertility). On average, less than half of these topics were addressed in daily clinical practice.
  
  
  CONCLUSIONS
  This study showed substantial overlap between benefits/harms that patients and oncologists consider important to address during the consultation, and at the same time poor congruence with daily clinical practice.
authors.affiliation: Department of Medical Decision Making, Leiden University Medical Center, The Netherlands. Electronic address: Kunneman@lumc.nl.
authors.forename: Marleen
authors.initials: M
authors.lastname: Kunneman
authors.affiliation: Department of Medical Decision Making, Leiden University Medical Center, The Netherlands.
authors.forename: Arwen H
authors.initials: AH
authors.lastname: Pieterse
authors.affiliation: Department of Medical Decision Making, Leiden University Medical Center, The Netherlands.
authors.forename: Anne M
authors.initials: AM
authors.lastname: Stiggelbout
authors.affiliation: Department of Clinical Oncology, Leiden University Medical Center, The Netherlands.
authors.forename: Corrie A M
authors.initials: CA
authors.lastname: Marijnen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D032921:Consensus; D003697:Delphi Technique; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D011300:Preoperative Care; D011832:Radiation Injuries / Q000175:diagnosis / Q000209:etiology*; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects / Q000379:methods; D012004:Rectal Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D015996:Survival Rate
keywords: Communication; Delphi-method; Information provision; Preoperative radiotherapy; Rectal cancer; Shared decision making