Barriers to the management of obstructed defaecation according to colorectal surgeons.
OBJECTIVE
Obstructed defaecation (OD) has a high prevalence and high disease impact; however, patients often experience suboptimal management. This problem reflects the complex pathophysiology of OD as well as health service delivery factors. This study aimed to identify the factors that act as a barrier to effective management of OD as perceived by specialist colorectal surgeons treating this disorder.


METHODS
A postal questionnaire was administered to a bi-national sampling of colorectal specialists in Australia and New Zealand who were registered with their specialty society. Questions addressed variables relevant in OD management, including clinical access, decision-making, patient factors and surgeon experience and perceptions, and used Likert scales. Statistical analyses compared surgeon practice variables.


RESULTS
The response rate was 68.5% (n = 113). Most surgeons managed OD (94%), and preferred to treat OD patients themselves (87%); however, 33% of these respondents were dissatisfied with their management, 46% felt they lacked management expertise and 33% stated they had inadequate expertise in OD investigations. Clinical investigation services were more limited in private than public practice, and many surgeons lacked access to biofeedback (31%). Other barriers included heterogeneity in decision-making by surgeon age and practice location (P < 0.05), dual pathologies (e.g. irritable bowel syndrome) and psychological factors, and limited uptake of multidisciplinary services and standardized (Rome) diagnostic criteria.


CONCLUSIONS
Barriers to OD management include surgeon-specific factors, patient-specific factors and healthcare access factors. Increased utilization of pelvic floor and multidisciplinary services, increased training and standardization of OD investigations and improved access to specialist investigations and allied-health management services could improve outcomes for OD.
Surgical Outcomes Research Centre (SOuRCe), Sydney Local Health District and Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia.|Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.|Department of Surgery, University of Auckland, Auckland, New Zealand.
N
N
Al-Mozany
Surgical Outcomes Research Centre (SOuRCe), Sydney Local Health District and Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia.|Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
C
C
Wright
Department of Surgery, University of Auckland, Auckland, New Zealand.
G
G
O'Grady
Surgical Outcomes Research Centre (SOuRCe), Sydney Local Health District and Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia.|Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
C J
CJ
Young
Surgical Outcomes Research Centre (SOuRCe), Sydney Local Health District and Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia.|Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.|Department of Surgery, University of Auckland, Auckland, New Zealand.
M J
MJ
Solomon
D000328:Adult; D001291:Attitude of Health Personnel; D001315:Australia; D003107:Colorectal Surgery / Q000523:psychology*; D003248:Constipation / Q000523:psychology / Q000628:therapy*; D003672:Defecation; D019468:Disease Management; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007415:Intestinal Obstruction / Q000523:psychology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D011795:Surveys and Questionnaires
Delivery of health care; constipation; pelvic floor; psychology