eP434 - “This Is Kind of a Scary Conversation”: A Qualitative Analysis of Patient-surgeon Communication About Rectal Cancer Treatment

Purpose/Background: Patients with rectal cancer face a potentially life-limiting disease with a substantial symptom burden, requiring consideration of multi-modal treatment options with possible trade-offs between survival and quality of life. Surgical consultations provide critical and early in-the-moment support of patients as they navigate care. Characterization of communication during clinic visits can identify: (1) unique challenges for patients with rectal cancer and (2) opportunities to optimize serious illness communication. This study aims to elucidate these patient-clinician interactions.Methods/Interventions: We performed secondary analysis of audio recorded clinic visits of patients with rectal cancer, and their families, with colorectal surgeons at 5 academic centers. The cohort included 18 patients seen by 8 surgeons. Four coders with backgrounds in surgery, communication, education, and palliative care used an inductive approach to open coding, assigning codes to constructs as they arose in the data. We iteratively revised the taxonomy via group consensus. We pursued higher level analysis aided by MIRO, an online software program for concept mapping and visualization, to map relationships and ensure the results faithfully represented the data. We characterized the relationship between tasks surgeons pursue during the visit and specific patient domains including physical symptoms, emotional concerns, and inclusion of priorities within a treatment plan.Results/Outcomes: Surgeons have four key tasks to accomplish during the clinic visit: establishing a shared account of the patient’s current illness and overall health, deliberating about treatment options, planning treatment, and preparing patients for treatment, recovery, and the trajectory of illness. Figure 1 illustrates how, as surgeons address each task, patients express a range of needs: emotional (distress around illness progression, prognosis, and hygiene-related social isolation), physical (current and future symptom management), and decisional (incorporation of patient priorities into treatment planning). Surgeons attend to patients’ multiple needs, often effectively, yet the overall objective of the clinic visit, multiple competing tasks, and complexity of treatment options can shift the focus of the conversation away from the patient’s needs, towards highly technical information.Conclusion/

Discussion: Colorectal surgeons encounter patients with rectal cancer at a time in the disease course when patients are encumbered by intense emotional, physical, and decisional needs. Surgical consultation for rectal cancer requires surgeons to balance two agendas: addressing patients’ needs and accomplishing the specific tasks to guide patients through treatment. A more intentional framework for these conversations and the use of advanced communication techniques might successfully support colorectal surgeons in integrating both agendas to improve care for patients with rectal cancer.Figure 1Tasks for surgeons to accomplish during the clinic visit and overlapping expression of patients’ needs.