EP730 - Factors influencing treatment decision-making among rectal prolapse patients

Monday, May 11, 2026

8:05 AM - 8:10 AM ET

ePoster Presenter(s)

Jessica Martinolich, MD

Assistant Clinical Professor
University at Buffalo
Buffalo, New York, United States

Disclosure information not submitted.

View ePoster

Author(s)

Joseph Sciacca, DO

Colorectal Fellow
University at Buffalo
University at Buffalo
Buffalo, NY, United States

Disclosure information not submitted.
AM

Ajay Myneni, MBBS, PhD. MPH

Research Scientist
University at Buffalo
buffalo, New York, United States

Disclosure information not submitted.
CK

Chaewon Kim, BS

Student
University at Buffalo
Buffalo, New York, United States

Disclosure information not submitted.
SJ

Sarah Johnson, MPH

Student
University at Buffalo
Buffalo, New York, United States

Disclosure information not submitted.
EL

Eve Lopez, MD

Resident Physician
SUNY Upstate
Buffalo., New York, United States

Disclosure information not submitted.
RC

Renee Cadzow, PhD

Assistant Professor, Department of Epidemiology and Enviornmental Health
University at Buffalo
Buffalo, New York, United States

Disclosure information not submitted.
LT

Laurene Tumiel-Berhalter, PhD

Associate Dean for Research
University at Buffalo
Buffalo, New York, United States

Disclosure information not submitted.

Senior Author(s)

EN

Ekaterina Noyes, PhD, MPH

Professor
University at Buffalo
Buffalo, New York, United States

Disclosure information not submitted.

Purpose/Background: Despite recent evidence of superb short and long term outcomes of transabdominal rectopexy procedures for the majority of patients with rectal prolapse (RP), approximately half of patients undergo perineal interventions. It is important to understand the reasons (such as patient preferences, clinician habits, physician financial incentives, or lack of awareness) why guideline-concordant practices are not always followed, while also identifying factors that can support the change, like value-based payment metrics, local champions, and IT support systems. This study, part of a mixed-methods, multi-level project, examined patient- and surgeon-level barriers to implementing current clinical guidelines for rectal prolapse, with a focus on increasing patient autonomy.

Methods/Interventions: Patients who underwent treatment for rectal prolapse in the Buffalo, New York metropolitan area were recruited with permission from their treating physicians. Semi-structured individual interviews were conducted to understand treatment decision process for rectal prolapse management. Based on validated questionnaires about decision quality and decision regret, patients were asked open-ended questions regarding urgency of disease process, and preferences for surgical treatment and post operative course. (n = 8, all women) The interviews were coded by two researchers using qualitative analysis software (Dedoose) to identify common themes.

Results/Outcomes: Many patients disclosed the limited awareness of shared decision making and their beliefs that doctors will always know what is best for their patients. As a result, only a few patients explored options to better address their needs including social barriers to health. Many women expressed a history of decision-making burden and fatigue and lack of confidence in treatment effectiveness due to a long history of unsuccessful management of multiple chronic conditions. As a result, most women favored less invasive over more effective treatments.

Conclusion/Discussion: While the key indicators of care quality are known to be adherence to current clinical guidelines and patient-centeredness, our findings show that in the situations when patients preferred perineal approach to RP management, there was limited discussion regarding alternatives. We suspect surgeons feel conflicted and therefore avoid shared decision-making or alternatively acquiesce to patient preference with limited further discussion. Sufficient clinician skills training and patient decision support are essential when de-implementing low-value interventions.