Consensus on Information Provision for Patients With Early-Stage Colorectal Cancer: A Delphi Study Among Healthcare Practitioners and Patients

Background: Patients with radically endoscopically treated T1 colorectal cancer (CRC) with at least one high-risk histopathological characteristic are presented with the choice between additional surgical resection with lymphadenectomy or intensive surveillance. Healthcare practitioners (HCPs) from various disciplines provide information on the complex trade-offs involved. Aim: We aimed to reach consensus on what information patients should be offered at the time of decision making. Methods: We invited HCPs and patients with early-stage (pT1-3N0M0) CRC to participate in a three-round online Delphi study. In the first round, participants were asked to indicate the relevance of 163 items regarding CRC surgery and intensive surveillance, using five-point Likert-type scales. The following rounds only included the items on which no consensus had been reached yet, supplemented with new items that participants had suggested in the previous round(s). Criteria for consensus were defined in advance. Results: Thirty percent (109/341) of the invited participants completed ≥ 50% of items in the first round. After the third round, consensus was reached on 80/154 items regarding colon cancer and 129/179 items regarding rectal cancer; of these, respectively, 40 and 47 items were considered relevant. HCPs tended to consider more frequently occurring complications relevant compared to patients. Patients also considered rare complications relevant but expressed worries about information overload. There was clear consensus on items regarding different types of surgery and recovery expectations, the risk of anastomotic leakage and of receiving a stoma, and the risk of recurrence after both surgery and intensive surveillance. Conclusion: A consensus-based, standardized set of information items was defined in order to facilitate that patients receive complete information in a uniform way. The results of this study aim to support patients and their HCPs to make a well-informed decision between additional surgical resection with lymphadenectomy and intensive surveillance.