EP712 - Conversations in Rectal Cancer Treatment: A Multidisciplinary Provider Perspective into Non-Operative Management Decision-Making Discussions

Purpose/Background: In select patients with locally advanced rectal cancer (LARC), non-operative management (NOM) after receipt of chemotherapy and radiation is an option that may decrease long-term bowel, bladder, and sexual dysfunction associated with surgical resection. However, there is limited research delineating how providers approach conversations around NOM. We examined the approaches to NOM discussions among medical oncologists, radiation oncologists, and colorectal surgeons caring for patients with LARC.

Methods/Interventions: A trained qualitative interviewer conducted 30-60-minute semi-structured virtual interviews. Recordings were transcribed, de-identified, and managed in NVivo 12. Data were analyzed using inductive thematic analysis; the team developed a codebook by consensus, and three coders met regularly to resolve discrepancies. Summary tables were created for each code to compare themes across provider types, and higher-level analysis was conducted through constant comparison and mind mapping. For this abstract, we report on communication strategies identified in the analysis.

Results/Outcomes: Eighteen clinicians were interviewed (3 medical oncologists, 3 radiation oncologists, 12 colorectal surgeons). Participants had diverse experience (44% < 10 years, 34% 10-20 years, 22% >20 years); most identified as White (83%), 17% as Asian, 33% were female, and the mean age was 46.5 years (range 34-58).

Clinicians approached discussions of NOM from distinct perspectives. Overall, surgeons had the most detail in their description of communication practices and use of different strategies to convey their message effectively and efficiently to patients. Four main themes emerged from our analysis. Conversational strategies included reserving longer appointment times for discussion, drawing on clinical trial evidence, and outlining options in structured pro-con lists. Surgeons often used percentages or risk estimates to contextualize choices, while patients were encouraged to take time for decision-making, consult family, conduct independent research, or seek second opinions. Examples from other patients and the consistent use of lay terminology helped simplify complex information. Tone and framing emphasized transparency and personalization. Providers were upfront that surgery and colostomy would be necessary if complete response was not achieved, but framed options in a positive, neutral manner that allowed patients to lead. Realistic expectations were set, particularly regarding the demands of NOM, while discussions of controllable aspects of care promoted patient agency. Established relationships eased later conversations, as patients were already introduced to NOM in brief exchanges; medical oncologists revisited the topic throughout neoadjuvant therapy, creating multiple opportunities for engagement. Treatment phase strongly influenced timing: NOM was only briefly acknowledged at initial consultation, then discussed in detail after chemoradiation if complete response was observed. Surgeons emphasized NOM during restaging, while medical oncologists often raised it earlier, after two to three months of chemotherapy.

Conclusion/Discussion: Effective communication about NOM in LARC relies on clear strategies, realistic framing, and established provider-patient relationships, with timing closely tied to treatment phase. Multidisciplinary, iterative discussions are essential to support informed patient decision-making.

Non-Operative Management Decision-Making Discussions