Dekkers Nik, Dang Hao, de Graaf Manon, Nobbenhuis Kate, Verhoeven Daan A, van der Kraan Jolein, de Vos Tot Nederveen Cappel Wouter H, Alkhalaf Alaa, van Westreenen Henderik L, Basiliya Kirill, Peeters Koen C M J, Westerterp Marinke, Doornebosch Pascal G, Hardwick James C H, Langers Alexandra M J, Boonstra Jurjen J
Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands.
Department of Gastroenterology and Hepatology, Isala Hospital, Zwolle, The Netherlands.
United European Gastroenterol J. 2024 Dec;12(10):1367-1377. doi: 10.1002/ueg2.12628. Epub 2024 Jul 19.
Decision-making after local resection of T1 colorectal cancer (T1CRC) is often complex and calls for optimal information provision as well as active patient involvement.
The aim was to evaluate the perceptions of patients with T1CRC on information provision and therapeutic decision-making.
This multicenter cross-sectional study included patients who underwent endoscopic or local surgical resection as initial treatment. Information provision was assessed using the EORTC QLQ-INFO25 questionnaire. In patients with high-risk T1CRC, we evaluated decisional involvement and satisfaction regarding the choice as to whether to undergo additional treatment after local resection, and the level of decisional conflict using the Decisional Conflict Scale.
Ninety-eight patients with T1CRC were included (72% response rate; 79/98 endoscopic and 19/98 local surgical resection; 45/98 high-risk T1CRC). Median time since local resection was 28 months (IQR 18); none had developed recurrence. Unmet information needs were reported by 29 patients (30%; 18 low-risk, 11 high-risk), mostly on post-treatment related topics (follow-up visits, recovery time, recurrence prevention). After local resection, 24 of the 45 high-risk patients (53%) underwent additional treatment, while others were subjected to surveillance. Higher-educated patients were more often actively involved in decision-making (93% vs. 43%, p = 0.002) and more frequently underwent additional treatment (79% vs. 40%, p = 0.02). Decisional conflict (p = 0.19) and satisfaction (p = 0.78) were comparable between higher- and lower-educated high-risk patients.
Greater attention should be given to the post-treatment course during consultations following local T1CRC resection. The differences in decisional involvement and selected management strategies between higher- and lower-educated high-risk patients warrant further investigation.
T1期结直肠癌（T1CRC）局部切除术后的决策通常很复杂，需要提供最佳信息并让患者积极参与。
旨在评估T1CRC患者对信息提供和治疗决策的看法。
这项多中心横断面研究纳入了接受内镜或局部手术切除作为初始治疗的患者。使用欧洲癌症研究与治疗组织（EORTC）QLQ-INFO25问卷评估信息提供情况。对于高危T1CRC患者，我们评估了其在局部切除后是否接受额外治疗这一选择上的决策参与度和满意度，以及使用决策冲突量表评估决策冲突水平。
纳入了98例T1CRC患者（应答率72%；98例中79例行内镜切除，19例行局部手术切除；98例中45例为高危T1CRC）。自局部切除后的中位时间为28个月（四分位间距18个月）；无患者出现复发。29例患者（30%；18例低危，11例高危）报告有未满足的信息需求，大多涉及治疗后相关主题（随访、恢复时间、预防复发）。局部切除后，45例高危患者中有24例（53%）接受了额外治疗，其他患者接受监测。受教育程度较高的患者更常积极参与决策（93%对43%，p = 0.002），且更常接受额外治疗（79%对40%，p = 0.02）。受教育程度较高和较低的高危患者在决策冲突（p = 0.19）和满意度（p = 0.78）方面相当。
在T1CRC局部切除术后的咨询过程中，应更加关注治疗后过程。受教育程度较高和较低的高危患者在决策参与度和所选管理策略上的差异值得进一步研究。
