Search

Oncology clinicians often miss opportunities to communicate empathy to patients. The current study examined the relationship between implicit bias (based on cancer type and ethnicity) and medical students' empathic communication in encounters with standardized patients who presented as Hispanic (lung or colorectal) individuals diagnosed with cancer. Participants (101 medical students) completed the Implicit Association Test (IAT) to measure implicit bias based on cancer type (lung v. colorectal) and ethnicity (Hispanic v. non-Hispanic White). Empathic opportunities and responses (assessed by the Empathic Communication Coding System; ECCS) were evaluated in a mock consultation (Objective Structured Clinical Examination; OSCE) focused on smoking cessation in the context of cancer. Among the 241 empathic opportunities identified across the 101 encounters ( M  = 2.4), 158 (65.6%) received high empathy responses from the medical students. High empathy responses were most frequently used during challenge (73.2%) and emotion (77.3%) opportunities compared to progress (45.9%) opportunities. Higher levels of implicit bias against Hispanics predicted lower odds of an empathic response from the medical student ( OR  = 3.24, p  = .04, 95% CI = 0.09-0.95). Further work is needed to understand the relationship between implicit bias and empathic communication and inform the development of interventions.

Objective: Gender could impact the psychosocial outcomes and coping strategies of cancer patients and their spousal caregivers (SCs). This study aims to develop a gender-concerned program for colorectal cancer (CRC) couple-based mutual communication intervention (MCI) and to assess its effectiveness on the intra-couple relationship and the individual functions of the partners., Design: A randomized clinical trial with two study groups was utilized., Methods: A total of 144 CRC patients and their SCs were randomly assigned to either MCI or usual care (UC) groups, and all of them were required to complete the measurements at baseline and post-intervention. The primary outcome was for mutual communication, and the secondary outcomes included dyadic coping, relationship satisfaction, anxiety, depression, benefit finding and quality of life. The data were analysed by multi-level modelling., Results: The MCI program was feasible and acceptable for Chinese CRC couples and was effective for the improvement of the intra-couple relationship and the individual functions of each partner. CRC patients showed more improvement in mutual communication and dyadic coping than their SCs in the MCI group. Also, this intervention effectiveness was found to be independent of gender., Conclusions: The MCI program is beneficial for Chinese CRC couple's adaptation outcomes. This suggests that clinical medical staff should consider the gender tendency during the implementation of interventions. More researches are needed to extend the application of the MCI program to different participants (e.g. patients with the diagnosis of other types of cancer and their SCs)., (© 2024 British Psychological Society.)

Purpose: Colorectal cancer threatens health and causes heavy social burdens. The purpose of this study is to analyze the pathway model for the effect of self-efficacy on self-management ability in colorectal cancer patients with stoma., Methods: A cross-sectional study was conducted from December 2022 to April 2023, with a convenience sample of 422 colorectal cancer patients with stoma at six tertiary grade A hospitals in Shandong Province, China. Statistical analysis was undertaken using SPSS 26.0 and Amos 24.0 software. A pathway model based on individual and family self-management theories was developed and analyzed by collecting data through onsite survey and online survey., Results: Chinese colorectal cancer patient's self-management ability score is 105.19 (17.19), which shows medium-level self-management ability. The self-efficacy of colorectal cancer patients with a stoma is influenced by social support, which ultimately leads to changes in their self-management ability., Conclusion: The findings may help healthcare professionals to identify the factors that influence self-management skills of colorectal cancer patients with stoma and provide a basis for developing interventions., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: The preoperative period provides a window of opportunity to improve modifiable risk factors for treatment complications such as malnutrition, the so-called prehabilitation. Identifying factors related to adherence to nutritional interventions is essential for optimizing prehabilitation programs. The aim of this study is to evaluate a nutritional support module as part of a teleprehabilitation program in high-risk patients with colorectal cancer (CRC)., Methods: A secondary analysis with a mixed method design of the nutritional support module of a pre-post teleprehabilitation pilot study was performed. Change in weight, complaints with intake, motivation, and subjective and objective adherence were evaluated., Results: Eleven patients were included. Subjectively, six patients (55%) were able to adhere to the nutritional advice. Despite that, nine of eleven (82%) patients experienced difficulties with the amount of food that was advised by the dietician. Six of eleven (55%) patients gained weight during the prehabilitation program. After prehabilitation, nine of eleven (82%) were able to reach 100% of their energy requirement and six of eleven (55%) were able to reach 100% of their protein requirement. Differences between patients in motivation and/or having complaints did not seem to be associated with protein and energy intake., Conclusion: This secondary analysis of a pilot study provides insights into understanding patients' experiences with a nutritional support module as part of a teleprehabilitation program. With 82% of patients who were able to reach 100% of their energy requirement, teleprehabilitation seems to be feasible, while there is still room for improvement with respect to protein intake as only 55% of patients reached a sufficient intake., (© 2024. The Author(s).)

Objective: A comprehensive understanding of coping strategies of patients with advanced diseases can contribute to providing supportive care that meets patients' needs. However, insight into how coping of this population develops over time is lacking. We examined coping strategies of patients with advanced cancer over time and identified distinct trajectories and their predictors., Methods: Data from 675 patients of the control group from the ACTION cluster-randomized trial were analyzed. Patients with lung or colorectal cancer from six European countries (Belgium, Denmark, Italy, the Netherlands, Slovenia and the United Kingdom) completed questionnaires at baseline, 12 and 20 weeks. Measures included Denial, Acceptance, and Problem-focused coping (COPE, Brief COPE inventory; scores 4-16 per scale). We used linear mixed models to analyze the data and latent class mixed models to identify stable (within patient change < 2) coping strategies., Results: At baseline, patients reported low use of Denial (6.6) and greater use of Acceptance (12.6) and Problem-Focused coping (12.2). These scores did not significantly change. We found four distinct trajectories for the use of Denial, three for Acceptance and five for Problem-Focused coping strategies. Stable trajectories were found in 513 (77%) patients for Denial, 645 (96%) for Acceptance and 602 (91%) for Problem-Focused coping. All coping strategies were stable in 447 (68%) patients and two were stable in 181 patients (28%)., Conclusions: Overall, the use of coping strategies was rather stable in the majority of patients with advanced cancer. However, for each of the coping strategies subgroups of patients reported fluctuating coping trajectories., (© 2024 The Author(s). Psycho‐Oncology published by John Wiley & Sons Ltd.)

Purpose: this study aims to develop and test a model examining the causal relationship between self-efficacy, social support, fatigue, pain, functional status, and health-related quality of life (HRQL)., Methods: A cross-sectional correlation study was conducted using a multi-stage sampling technique to recruit 256 individuals aged 20 to 59 with colorectal cancer (CRC) post-surgery from three hospitals in Northern Vietnam. The hypothesized model, based on Ferrans' HRQL conceptual model and literature review, was validated using structural equation modeling (SEM) and Mplus., Results: the model fit the data well, explaining 52% of the variance of HRQL. Self-efficacy emerged as the most influential factor directly impacting HRQL (β = .494, p < .05) and also had negative indirect effects on HRQL through fatigue and pain (β = -.271, p < .05). Social support had a positive direct (β = .406, p < .001) and negative indirect effects on HRQL via fatigue and pain (β = -.143, p < .05). Fatigue and pain had negative indirect effects on HRQL through functional status (β = -.336, p < .05 and β = -.219, p < .05, respectively). Functional status had a positive direct effect on HRQL (β = .418, p < .001)., Conclusions: The study's findings highlight the importance of improving self-efficacy, social support, and functional status, while reducing fatigue and pain to enhance HRQL among individuals with CRCpost-surgery. These insights can inform the development of targeted interventions to improve the well-being of this population., Competing Interests: Declaration of competing interest The authors declare no competing interest with respect to the research, authorship and/or publication of this article., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objectives: Patients with colorectal cancer (CRC) reported experiencing subjective cognitive impairment (SCI), and their spousal caregivers perceived the patients' SCI. This cross-sectional study assessed the congruence of SCI between the patients' self-reports and the spousal caregivers' perceptions and examined the factors affecting SCI from the dyadic perspective., Methods: A total of 200 dyads of patients with CRC and their spousal caregivers were invited to complete the survey, which evaluated the SCI, dyadic coping (DC), quality of life, anxiety, and depression for the dyads. Congruence was analyzed using the intraclass correlation coefficient (ICC) and paired-sample t test. Impacting factors analysis was conducted using Pearson correlations, hierarchical multiple regression, and actor-partner interdependence mediation model., Results: The congruency of SCI between the patient-reported and the spouse-perceived ranged from moderate to good (ICC = 0.75 to 0.86). After controlling demographic variables (the patients' gender and spouses' work status), the DC of both patients and spousal caregivers, and the emotional health of patients were significant predictors for patients' SCI (all P < .05). In the actor-partner interdependence mediation model, there was an actor effect between DC and SCI for both patients and spousal caregivers and a partner effect between DC and SCI for patients. Moreover, patients' emotional health (anxiety and depression) had the mediating effect between DC and SCI for both patients and spousal caregivers., Conclusion: Spousal caregivers played a vital role in assessment and management in the SCI of patients. The DC of patients and spousal caregivers and the emotional health of patients (eg, anxiety and depression) were major predictors for the SCI of patients., Implications for Nursing: Nursing providers should consider the importance of patients' and spousal caregivers' perspectives in assessing and managing SCI. This study supports nurses focusing on the congruence and interrelationship of SCI to enhance DC for CRC patients and their spousal caregivers. This approach aims to reduce emotional distress and develop cognitive interventions from a dyadic perspective., Competing Interests: Declaration of competing interest The authors state that this study has no business or financial relationships with potential conflicts of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)

The purpose of the present study was to investigate the quality of patient/clinician communication as one potential factor that impacts colorectal cancer screening behavior. As part of a larger randomized controlled trial conducted between 2011 and 2016 in the setting of community and academic family medicine or internal medicine practices in Michigan, USA, patients completed a pre-encounter survey, completed their regularly scheduled visit with their primary care clinician (which was audio-recorded), completed a post-encounter survey, and allowed 6-month follow-up chart audit. We trained 10 coders to rate 216 of the audio-recorded conversations between 216 patients and their primary care physicians for 6 specific features of communication quality (using 7-point scales), including the extent to which participants enacted attention to medical content, engagement, emotional expression, relationships, face, and accommodation. At least 3 coders rated each conversation, and intraclass correlations (i.e., reliability assessment) were in the good to excellent range. We found that patient and clinician attention to face (an identity goal) was a significant predictor of colorectal cancer screening at 6 months follow up. Measuring communication in terms of attention to multiple goals reveals unexpected findings about the aspects of communication that impact colorectal cancer screening behavior. The focus of many interventions to improve colorectal cancer screening rates is on the content (i.e., task goals) of clinicians' communication (such as presenting the different options for screening), yet the content of communication was not a significant predictor of screening in the present study. Rather, clinicians' and patients' attention to identity goals predicted screening behavior, which suggests that interventions may not need to be overly complex and that simply improving the quality of attention to identity goals in clinician communication might be one of the most straightforward yet impactful ways to improve colorectal cancer screening uptake among patients., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Colorectal cancer (CRC) has emerged as one of the most common cancers, with increasing survival rates globally. As patients with CRC experience diverse treatment effects corresponding to different survival stages, understanding their unmet needs based on the survival stage is critical to tailor supportive care with limited medical resources., Aim: This study aimed to understand the unmet needs of patients with CRC across survival stages., Methods: This scoping review followed the 5-stage framework established by Arksey and O'Malley. Five online databases were searched with narrative synthesis performed after data extraction., Results: Fifteen studies were identified for this review, with 12 focusing on the acute survival stage and three reporting on the extended survival stage. Ten studies used validated scales to assess unmet needs, with the Supportive Care Needs Survey being the most common scale. Unmet needs in patients with CRC demonstrate distinct patterns across survival stages. Most studies reported a higher prevalence of unmet needs during the extended survival stage compared to the acute survival stage. Unmet emotional needs predominate during the acute survival stage, whereas unmet physical needs become most prominent in the extended survival stage., Linking Evidence to Action: Healthcare providers are encouraged to conduct assessments tailored to the specific survival stage, with particular emphasis on addressing unmet needs during the extended survival stage. The development of standardized scales is recommended to comprehensively assess the unmet needs of patients with CRC., (© 2024 Sigma Theta Tau International.)

Colorectal cancer (CRC) remains the third leading cause of cancer death in the USA. Latinx adults are overrepresented in late-stage CRC diagnosis as CRC screening utilization remains low among Latinx-identifying individuals. This study aims to evaluate the effect of a theory-based narrative video following a culturally appropriate storyline on CRC screening intention, knowledge, and psychosocial variables along the U.S.-Mexico border. We designed and analyzed a non-randomized pre-posttest evaluation of a narrative, culturally tailored video embedded within a community program. The study is set in the U.S.-Mexico border community. Outreach provided a link or QR code to access the survey. In all, 458 participants started the survey, and 304 completed the survey. Participants were recruited through flyers distributed throughout various community events by the program's community health workers and via social media. The intervention evaluated changes in participant's knowledge, perceived barriers, perceived susceptibility, self-efficacy, and perceived benefits and intention to screen. Participants were a mean age of 39 and identified mainly as female (72.7%) and Hispanic/Latinx (88.49%). After viewing the narrative video, participants had significantly improved perceived susceptibility, self-efficacy, and benefits, while perceived barriers and sense of fatalism significantly decreased. Paradoxically, this was associated with a significant decrease in knowledge scores. Results from this intervention suggest that a theory-based narrative video following a culturally appropriate storyline effectively improves psychosocial variables and intention to carry out CRC screening in a predominantly Hispanic border population., (© 2024. The Author(s) under exclusive licence to American Association for Cancer Education.)

We explored longitudinal associations between religion/spirituality (R/S) Salience and R/S Attendance, and colorectal cancer screening, among adults aged ≥ 50 years in Alberta, Canada. R/S Salience was not statistically significantly associated with colorectal cancer screening (adjusted odds ratio [aOR]: 1.06, 95% confidence interval [CI] 0.88-1.28). Conversely, R/S Attendance was statistically significantly associated with higher odds of colorectal cancer screening: the aOR was 1.28 (95% CI 1.02-1.59) for participants attending services at least once a month and 1.31 (95% CI 1.01-1.69) for participants attending between one and four times yearly, compared to participants who never attended. Researchers should explore the possibility of delivering colorectal cancer screening programs in R/S settings., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: This study aimed to determine the postoperative intestinal functioning, quality of life (QoL), and psychological well-being of patients treated either with organ-preserving surgery (OPS) or organ-resection surgery (ORS) for high-grade intraepithelial neoplasia (HIN) or T1 colorectal cancer (CRC)., Methods: This cross-sectional study was conducted at a single tertiary care center. In total, 175 eligible individuals with T1 CRC or HIN were divided into the OPS (n = 103) or ORS (n = 72) group based on whether the relevant segment of the intestine was preserved or resected. Intestinal function was evaluated using low anterior resection syndrome (LARS) scores. QoL was evaluated using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ)-C30 and EORTC-QLQ-CR29. Psychological status was evaluated using the Fear of Progression Questionnaire-Short Form and the Self-rating Anxiety and Depression scales. Propensity score matching (PSM) was used to minimize the influence of potential confounders., Results: Overall, 130 of 175 patients (74.29%) responded to the questionnaires; 56 and 74 were in the ORS and OPS groups, respectively. Thirty-five patient pairs were successfully matched through PSM. The mild and severe LARS rates were significantly higher in the ORS group than in the OPS group (P < 0.001). The EORTC-QLQ-C30 and EORTC-QLQ-CR29 scores revealed significantly better physical, role, and emotional functioning and an overall improved state of health (with multiple reduced symptom scores) in the OPS group than in the ORS group (P < 0.05). Significantly more patients were depressed in the ORS group than in the OPS group (P = 0.034), whereas anxiety or fear of disease progression did not differ significantly between the groups., Conclusions: OPS for the treatment of HIN or T1 CRC was found to be more advantageous for patients in terms of improved intestinal function, QoL, and psychological status than was ORS., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Purpose: Research investigating depressive symptoms among cancer patients rarely distinguish between core symptoms of depression (motivational and consummatory anhedonia, and negative affect). This distinction is important as these symptoms may show different trajectories during the course of the illness and require different treatment approaches. The aim of the present study is to investigate fluctuations in core depressive symptoms in patients with colorectal cancer (CRC). It is hypothesized that these core depressive symptoms fluctuate differently during the course of the illness and depend on the phase of the illness (diagnostic, treatment, recovery and palliative phase)., Method: This study is based on data from the PROCORE study. PROCORE is a prospective, population-based study aimed to examine the longitudinal impact of CRC and its treatment on patient-reported outcomes. Eligible patients completed self-report questionnaires (i.e. Multifactorial Fatigue Index, Hospital Anxiety and Depression scale, EORTC-C30) after diagnosis, after surgery and at one and two years after diagnosis., Results: In total, 539 patients participated of whom 68 have died until March 1ste 2021. Core depressive symptoms fluctuated differently during the course of the illness with higher levels of motivational anhedonia during treatment and palliative phase (P<.001), consummatory anhedonia at the palliative phase (p < .001) and negative affect at the diagnostic and palliative phase (P<.001)., Conclusion: It is important to distinguish between different core depressive symptoms as they fluctuate differently during the course of an illness like CRC. The various depressive symptoms may require a different treatment approach at specific moments during the illness process.

This study examined the association among cancer history, social support, and up-to-date colorectal cancer (CRC) screening among four racial/ethnic groups. We conducted a cross-sectional analysis using data on respondents aged 45 to 75 years from the 2022 Behavioral Risk Factor Surveillance System. Our outcome of interest was CRC screening and exposures of interest were race/ethnicity, cancer history, and social support. Weighted multivariable logistic regression was performed. Among 73,869 adults, the CRC screening rate was 66.8% with the highest rate in non-Hispanic (NH), Whites (72.2%), and the lowest in Hispanics (52.6%). Screening rates were higher in adults with a cancer history (81.9%) and those having social support (69%). Hispanic adults with a cancer history had lower screening use (50.9% vs. 77.4% in the no cancer history group; P value < 0.001). Regardless of race/ethnicity, adults without social support had lower screening utilization (P value < 0.05). In effect modification, NH White adults who reported no cancer history and lack of social support were 12% less likely to have CRC screening than those with social support but without cancer history (OR, 0.88; 95% confidence intervals, 0.79-0.98). Similar results were observed among Hispanic adults without a cancer history and social support, with 37% less likely to have CRC screening than those with social support but no cancer history (OR, 0.63; 95% confidence intervals, 0.42-0.93). NH White and Hispanic adults without a cancer history and limited social support were less likely to have CRC screening uptake. By implementing culturally tailored interventions that address social support needs, greater CRC screening compliance may be increased among these populations. Prevention Relevance: Adherence to CRC screening recommendations reduces cancer incidence and mortality. Effective implementation of culturally tailored interventions that address social support needs and consider cancer history have the potential for improving CRC screening compliance among NH White and Hispanic adults without a cancer history., (©2024 American Association for Cancer Research.)

Objectives: This study aims to identify the primary factors influencing health-related quality of life (HRQoL) in patients with colorectal cancer (CRC), hypothesising that specific patient characteristics and clinical factors significantly impact HRQoL., Design: This was a cross-sectional study conducted over 1 month, from 1 April 2022 to 1 May 2022., Setting: The study was conducted in five hospitals in the northwest region of Iran, focusing on outpatient chemotherapy services., Participants: A total of 251 patients diagnosed with colon and rectal cancer participated in the study. Inclusion criteria included a confirmed diagnosis by an oncologist, ability to communicate, willingness to participate and being aware of their diagnosis and treatment. Exclusion criteria were the presence of other chronic diseases, cognitive disorders, known mental disorders and unwillingness to participate., Interventions: No interventions were applied as this was an observational study., Primary and Secondary Outcome Measures: The primary outcome was the HRQoL of patients with CRC, measured using a standardised SF-36 (36-Item Short Form Health Survey) questionnaire. Secondary outcomes included the impact of demographic and clinical factors on HRQoL., Results: The total score of HRQoL in these patients is 47.22±16.78, which indicates that HRQoL is disturbed in these patients. Also, the results of the stepwise multiple regression revealed that among all the participants' characteristics considered, seven factors: not having another disease besides cancer (p<0.001, β: 12.91, 95% CI 8.40, 17.42), only receiving chemotherapy (p<0.001, β: 9.10, 95% CI 4.12, 14.09), not having colostomy (p<0.001, β: 10.27, 95% Cl 5.70, 14.84), female sex (p=0.046, β: -4.52, 95% Cl -8.95, -0.08), living in their own house (p=0.001, β: 11.25, 95% Cl 4.77, 17.73), living in city (p=0.002, 17.74, 95% Cl 6.51, 28.96) and finally not having a job (p=0.003, β: -7.47, 95% Cl -12.31, -2.63), including are the factors that have the most predictive power in HRQoL., Conclusions: The findings of this study encourage health service providers and planners to pay special attention to the characteristics of patients with CRC as identified in this study. Notably, several HRQoL scores in patients with CRC are low, and the study found that patient characteristics, such as the presence of colostomy, unemployment, female gender and comorbidities, significantly predict the overall HRQoL score. Future research should focus on interventional studies aimed at minimising the adverse effects of disease symptoms on HRQoL in these vulnerable patients., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Colorectal cancer (CRC) is one of the most prevalent cancers worldwide, with high morbidity and mortality rates. Nutritional status has emerged as a significant factor influencing the prognosis and survival of CRC patients. This comprehensive literature review examines the role of nutritional support in improving treatment outcomes, including the efficacy of interventions, patient quality of life (QoL), and the modulation of inflammatory responses. The findings suggest that tailored nutritional interventions improve clinical outcomes, enhance QoL, and reduce treatment-related complications, particularly by attenuating inflammation. Furthermore, the review highlights the cost-effectiveness of nutritional strategies and identifies key methods to enhance patient compliance with dietary recommendations. In conclusion, integrating nutritional support into CRC treatment plans is crucial for optimizing clinical management and improving patient well-being.

Objective: 'Sludge' refers to administrative burdens or frictions that preclude people from getting what they want or need (eg, duplicative forms, complicated instructions, long waiting times). This mixed methods study evaluated patients' perceptions of sludge in the colorectal cancer (CRC) screening process and some impacts of this sludge., Design: We employed an exploratory sequential mixed methods study design that comprised patient interviews and a patient survey. The interviews informed final survey revisions and captured contextual data about patients' experiences with sludge. Interview transcripts were inductively and deductively analysed to identify overarching themes. The survey quantified sludge, delayed or forgone screenings, screening experience (Net Promoter Score) and health system distrust (Health System Distrust Scale). We used χ 2 or t-tests for univariable comparisons and logistic or linear regressions to evaluate the association between cumulative sludge score and delayed or forgone screenings, screening experience and health system distrust. Results were integrated for interpretation., Setting: Southeastern United States., Participants: Patients who were 45-75 years of age, at average risk for CRC and had either completed or been referred for CRC screening (colonoscopy or stool-based test) within the previous 12 months., Results: 22 interview participants and 255 survey participants completed the study. 38 (15%) survey participants rated their screening experience as poor (Net Promoter Score=0-7 out of 10). The mean (SD) Health System Distrust Scale score was 22.4 (6.3) out of 45 possible points (higher score=greater distrust). Perceptions of sludge in the CRC screening process varied, with long waiting times and burdensome communication being the most common sources (58% and 35% of participants, respectively). Sludge was positively associated with delayed or forgone screenings (OR=1.42, 95% CI 1.28, 1.57, p<0.001), poor screening experience (OR=1.15, 95% CI 1.04, 1.28, p=0.009) and health system distrust (β=0.47, p<0.001). Qualitative findings add descriptive detail about sludge encountered, context to impacts experienced, and illustrate the heavy emotional impact of sludge: ' it just isn't worth it' ., Conclusion: Efforts to reduce sludge in the CRC screening process may improve timely completion of CRC screening, enhance patient experience and restore trust in the health system., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: Despite the increasing research on cancer patient caregivers, there is still a lack of detailed understanding about the experiences of spouses caring for elderly colorectal cancer patients. This study aimed to fill this gap by examining the caregiving experiences of spouses during palliative chemotherapy for elderly Chinese colorectal cancer patients., Methods: Using a qualitative descriptive design, we recruited spousal caregivers of elderly colorectal cancer patients undergoing palliative chemotherapy. Semistructured interviews were conducted, and thematic analysis was employed to analyse the data., Results: Sixteen caregivers aged 60 to 82 years participated in the interviews. The analysis revealed three main themes: ambivalence, multiple role adaptation to conflicts, and the coexistence of hope and pressure. These themes shed light on the behaviors of older caregivers and the challenges they face, including physical and psychosocial issues associated with aging., Conclusion: This study highlights the significant stress and challenges experienced by older caregivers, characterized by intertwined emotions such as anxiety about their spouses' health deterioration, exhaustion from long-term care responsibilities, and anticipation of treatment outcomes., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Colorectal cancer (CRC) is globally the third most prevalent cancer and a leading cause of cancer-related deaths. In Alberta, Canada, a significant portion of CRC diagnoses occur following emergency department (ED) presentations. Gaps remain in understanding patient's perspectives on CRC diagnosis after an ED visit. The aim of this study was to examine the experiences and perspectives of a group of patients diagnosed with CRC subsequent to an ED visit in Alberta and their close contacts., Methods: We conducted a qualitative study using in-depth, semi-structured interviews with patients diagnosed with CRC after an ED visit at the Rockyview General Hospital, Calgary, and their close contacts, from November 2022 to June 2023. Interviews focused on symptom recognition, healthcare interactions, and the decision-making process leading to an ED visit. They were conducted in-person or over the phone, and analysed using thematic analysis., Results: Eighteen participants (12 patients and 6 close contacts) were interviewed, revealing four main themes: (1) variability in symptom recognition and interpretation; (2) inconsistencies in primary care consultations; (3) factors influencing decision-making leading to an ED visit; and (4) recommendations for expedited diagnosis outside of EDs., Conclusion: The findings highlight the complexity of the diagnostic journey for CRC patients in Alberta, pointing to significant gaps in symptom recognition and response by patients and healthcare providers. Improved diagnostic protocols and targeted support for healthcare providers, as well as approaches to address systemic delays may help streamline the diagnostic journey. Future research should focus on exploring innovative interventions to address the identified barriers to timely CRC diagnosis., (© 2024. The Author(s).)

Purpose: Studies evaluating oncological inpatient rehabilitation rarely include follow-up intervals beyond 6 months and larger proportions of patients other than those with breast cancer. Therefore, this study investigated changes in health-related quality of life (HRQoL), depression, and fear of progression of patients with breast, colorectal, or prostate cancer from the beginning to the end of oncological rehabilitation and a 9-month follow-up., Methods: Three hundred seventy-seven patients with breast, colorectal, or prostate cancer undergoing oncological inpatient rehabilitation (median age 61 years, 49% female) completed the EORTC QLQ-C30, the PHQ-9, and the FoP-Q-SF at each measurement point. Data analysis used 3 (tumor site) × 3 (time of measurement) repeated measures ANCOVAs with patient age and time since diagnosis as covariates. At each time point, we also compared our sample to the general population on the measures used., Results: Having controlled for the covariates, we found significant effects of tumor site, which were small except for Diarrhea. Effects of time of measurement were often significant and in part at least medium in size indicating improvement of HRQoL and depression during rehabilitation. At follow-up, some HRQoL domains and depression deteriorated. Women with breast cancer, in particular, showed a greater decrease in emotional functioning then. Compared to the general population, the sample's HRQoL and depression were significantly worse on most occasions., Conclusion: Oncological inpatient rehabilitation may improve HRQoL. The subsequent and in part differential deterioration in some HRQoL domains suggests a need for further follow-up care within survivorship programs., (© 2024. The Author(s).)

Introduction: Colorectal cancer (CRC) is the second leading cause of cancer deaths in the United States. Surveillance colonoscopy is recommended 1-year after surgical resection for patients with stage I-III CRC; however, only 18%-61% of CRC survivors complete this test. This study describes clinician-identified barriers and facilitators to surveillance colonoscopy among CRC survivors., Methods: We conducted semi-structured interviews with clinicians until thematic saturation was achieved. Interviews were analyzed using the social cognitive theory., Results: Thirteen clinicians were interviewed, and all identified health system-level barriers to surveillance colonoscopy completion; the most common being fragmented care due to patients receiving care across many health systems. Clinicians also identified social determinants of health barriers (e.g., geographical distance between patients and health systems) to 1-year surveillance colonoscopy completion., Conclusions: Clinicians identified several potentially modifiable barriers to 1-year surveillance colonoscopy completion which, if addressed, could improve post-treatment care and outcomes among stage I-III CRC survivors., (© 2024 The Author(s). Cancer Medicine published by John Wiley & Sons Ltd.)

Background: This cross-sectional study explored how masculinity beliefs may influence colorectal cancer (CRC) screening participation among ethnic subgroups of screening-age-eligible (45-75 years) Hispanic/Latino men., Methods: Using a consumer panel, we recruited self-identified Hispanic/Latino men fluent in English or Spanish, and residing in Florida, New York, or Texas. The Masculinity Barriers to Medical Care (MBMC) scale and its six subscales were used to assess masculinity beliefs. Multivariable logistic regression was used to estimate the association between MBMC and CRC screening participation, adjusting for Hispanic/Latino subgroup, marital status, survey language, age group, and health insurance status. Results were then stratified by Hispanic/Latino subgroup., Results: Of the participants (n=611), approximately 31% identified as Puerto Rican, 30% as other Hispanic/Latino, 26% as Mexican, and 14% as Cuban; 63% had ever been screened for CRC. We found no differences in the prevalence of screening participation by Hispanic/Latino subgroup. The majority of participants had completed both a stool-based test and an exam-based screening test (29.3%). After adjusting for confounding, MBMC reduced the odds of screening participation. Slight MBMC-subscale differences were observed by Hispanic/Latino subgroup. For example, higher scores on the Restrictive Emotionality subscale were associated with a lower likelihood of screening participation among Puerto Rican men, but higher odds of screening for Cuban men., Conclusions: Masculinity barriers to CRC screening may exist. Tailored interventions to address masculinity barriers among specific Latino subgroups may improve CRC screening uptake in this population., (© 2024 The Author(s). Cancer Medicine published by John Wiley & Sons Ltd.)

Background: With the burden of colorectal cancer in Canada, there is a need to address the psycho-oncologic challenges, including mental health. This study aims to explore the lived mental health experiences in patients with CRC across the phases of the CRC care continuum., Methods: We employed a patient-oriented constructivist grounded theory design and recruited English speaking participants ≥18 years, diagnosed with CRC within the last 10 years, residing in Canada. We collected data through semi-structured individual interviews using a guide co-constructed with patient research partners. Data collection and analysis were iterative, employed theoretical sampling, and culminated in a theoretical model., Results: Twenty-eight participants diagnosed with CRC (18 females, 10 males), aged 18-63 years at time of diagnosis were interviewed, with representation across all CRC stages. There were 10 participants (36%) in treatment, 12 participants (43%) in follow-up, and 6 participants (21%) in the beyond phase. We constructed a patient-oriented theory illustrating the dynamic nature between one's self-identity and their mental health experiences across the CRC care continuum. Mental health experiences encompass emotional and cognitive-behavioral responses, expressed differently across phases. Mental health care experiences are also shaped by barriers, facilitators, and individual contextual factors, all of which influence their access to care., Conclusion: Our theory provides insight into the mental health experiences of patients with CRC across phases of the CRC care continuum. Understanding patients' emotional and cognitive-behavioral responses and care experiences can help identify opportunities to integrate mental health into CRC care., (© 2024 The Author(s). Cancer Medicine published by John Wiley & Sons Ltd.)

Purpose: This study aimed to understand how health-related quality of life (HRQoL) differs by race/ethnicity in colorectal (CRC) survivors. We aimed to 1) examine racial/ethnic disparities in HRQoL, and 2) explore the roles of social determinants of health (SDOH) risk factors for HRQoL differ by racial/ethnic groups., Methods: In 2,492 adult CRC survivors using Behavioral Risk Factor Surveillance System (BRFSS) survey data (from 2014 to 2021, excluding 2015 due to the absence of CRC data), we used the Centers for Disease Control and Prevention (CDC) HRQoL measure, categorized into "better" and "poor." Multivariate logistic regressions with prevalence risk (PR) were employed for our primary analyses., Results: Compared with non-Hispanic Whites (NHW), non-Hispanic Blacks (NHB) (PR = 0.61, p = .045) and Hispanics (PR = 0.32, p < .001) reported worse HRQoL in adjusted models. In adjusted models, unemployed/retired and low-income levels were common risk factors for worse HRQoL across all comparison groups (NHW, NHB, non-Hispanic other races, and Hispanics). Other SDOH associated with worse HRQoL include divorced/widowed/never married marital status (non-Hispanic other races and Hispanics), living in rural areas (NHW and NHB), and low education levels (NHB and Hispanics). Marital status, education, and employment status significantly interacted with race/ethnicity, with the strongest interaction between Hispanics and education (PR = 2.45, p = .045) in adjusted models., Conclusion: These findings highlight the need for culturally tailored interventions targeting modifiable factors (e.g., social and financial supports, health literacy), specifically for socially vulnerable CRC survivors, to address the disparities in HRQoL among different racial/ethnic groups., (© 2024. The Author(s).)

Introduction: Colorectal cancer (CRC) and its therapy profoundly affect the quality of life (QoL) of patients. The emotional distress: anxiety and depression also negatively affect wellbeing of these patients. This study aims to evaluate the QoL, anxiety, and depression in CRC patients and their association with clinic-pathological features at a tertiary care hospital in Karachi Pakistan, a low middle income country., Methods: An analytical cross-sectional study was conducted on adult CRC patients. QoL was assessed using the European Organization for Research and Treatment of Cancer QoL questionnaire C30 and CR29. Hospital Anxiety and Depression Score was used to evaluate the anxiety and depression. Analyses were performed using STATA version 12, including multivariable linear and multivariate analysis of variance. A P value of < 0.05 was considered as significant., Results: A total of 127 CRC patients with mean age of 53 ± 15 y participated. Mean global QoL score was 69.08 ± 1.78. Among symptoms scales: stoma care problem and among functional scales: sexual interest (women > men) were the most significantly affected aspect. Anxiety and depression were seen in 26 (20.9%) and 24 (18.9%) patients, respectively. Lower global QoL was significantly associated with depression (-25.33 [95% confidence interval: -34.4, -16.23]), on adjuvant treatment (-15.14 [-21.84, -8.44]), and neoadjuvant treatment (-11.75 [-19.84, -3.65])., Conclusions: This is the first study assessing the QoL in CRC patients in Pakistan. Depression was found to be significantly associated with poor QoL. Numerous factors correlated with low QoL scores indicating the need to develop local guidelines to address psychological distress in our patients., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: To further understand the barriers and facilitators to attending colonoscopy examination following a positive routinely offered stool test result, from the perspective of patients and Specialist Screening Practitioners (SSPs)., Methods: Qualitative semi-structured interviews were conducted. Participants ( N =  32) were patients ( n  = 20) who, as part of the Bowel Cancer Screening Programme (BCSP) in England, were invited to attend a colonoscopy examination, and SSPs ( n =  12), who worked for the BCSP in England. Framework analysis included inductive and deductive coding., Results: Anxiety was as a key barrier cited by patients and SSPs, arising from the moment the patient received the invitation letter. Notably, procedural-related anxieties centred upon the fear of pain and discomfort and test invasiveness. The role of family, friends and the SSP were recognised by patients and SSPs to facilitate participation. Many patients, yet not SSPs, emphasised an obligation to attend all medical test invitations., Conclusion: Practically orientated strategies suggested by patients and SSPs address the patient barriers identified. These include earlier information to patients on the option of sedation for pain relief, earlier notification of potential financial support for patients unable to fund their own travel costs, and fewer uses of the term cancer within written materials.

Background: Colorectal cancer is the third most frequently diagnosed cancer worldwide, disproportionally affecting older people. With modern treatment, older people are surviving cancer treatment and recovery. However, only a limited number of studies on the older person's experience of recovery exist. Knowledge of the experience of recovery among people 80 years or older is essential to optimize recovery and follow-up care., Objective: The aim of this study was to explore the experiences of persons 80 years or older during recovery up to 2 years after curative colorectal cancer surgery., Methods: This exploratory inductive qualitative study was conducted through 18 individual in-depth interviews between July 2020 and June 2021. Content analysis was used to analyze the data., Results: The main theme identified was Recovery among the old is a complex process . It indicated that older people operated on for colorectal cancer may have intricate health challenges that affect recovery in addition to their cancer and treatment. The main theme is built upon the subthemes Individual factors affect colorectal cancer recovery and External support systems facilitate and impede colorectal recovery., Conclusion: Important resources for recovery among old patients included their own coping ability and support from social networks and healthcare services. The identified barriers to recovery included other health problems and issues with healthcare services delivery., Implications for Practice: It is essential for healthcare personnel in contact with older patients to be aware of factors that influence their recovery to identify and preserve the older person's resources and implement health-promoting initiatives to optimize recovery when needed., Competing Interests: The authors have no funding or conflicts of interest to disclose., (Copyright © 2023 The Authors. Published by Wolters Kluwer Health, Inc.)

Background and Objectives: Increasing longevity and advances in treatment have increased the cancer burden in the elderly, resulting in complex follow-up care needs; however, in China, little is known about the follow-up care preferences of these patients. This study quantified older cancer patients' preferences for follow-up care and examined the trade-offs they are willing to make to accept an alternative follow-up model., Methods: A discrete choice experiment was conducted among inpatients aged over 60 years with breast, prostate, or colorectal cancer, at two large tertiary hospitals in Nantong, China. Preference weights for follow-up care were estimated using mixed logit analysis. Subgroup analysis and latent class analysis were used to explore preference heterogeneity., Results: Complete results were obtained from 422 patients (144 with breast cancer, 133 with prostate cancer, 145 with colorectal cancer), with a mean age of 70.81 years. Older cancer patients stated a preference for follow-up by specialists over primary healthcare (PHC) providers ( β = -1.18, 95% confidence interval -1.40 to -0.97). The provider of follow-up care services was the most valued attribute among patients with breast cancer (relative importance [RI] 37.17%), while remote contact services were prioritized by patients with prostate (RI 43.50%) and colorectal cancer (RI 33.01%). The uptake rate of an alternative care model integrating PHC increased compared with the baseline setting when patients were provided with preferred services (continuity of care, individualized care plans, and remote contact services)., Conclusion: To encourage older cancer patients to use PHC-integrated follow-up care, alternative follow-up care models need to be based on patients' preferences before introducing them as a routine option., (© 2024. The Author(s).)

Objective: Molecular or biomarker testing to guide targeted treatments for colorectal cancer (CRC) has advanced care, specifically by improving treatment specificity. Our objective was to explore patients' experiences and perspectives with biomarker testing in Canada., Methods: We conducted a mixed-methods study among adults (≥ 18 years) who have been diagnosed with CRC and able to communicate in English. Quantitative data was gathered using an online survey, with questions on awareness of and experiences with biomarker testing. Qualitative data was gathered using semi-structured interviews with a sample of survey respondents to provide context to survey findings., Results: Among 55 survey respondents, 76% have heard of biomarker testing and of these, 67% have had biomarker testing done. Among the 33% of respondents that have not had biomarker testing done, reasons were: not offered/referred, fear/anxiety over results, and cost. Respondents who had biomarker testing largely found biomarker testing useful (89%), though, only half indicated that they were able to understand the information on their biomarker testing report. Qualitative analysis of interview transcripts identified four themes: 1) perceived benefits of biomarker testing, 2) knowledge of biomarker testing, 3) experiences with accessing and receiving biomarker testing, and 4) recommendations for addressing challenges with biomarker testing., Conclusion: Altogether, our study provides insight into CRC patients' perspectives and experiences with biomarker testing. Ongoing efforts by patient organizations, providers, and policymakers to improve awareness and access to biomarker testing must be informed by the patient perspective., (© 2024. The Author(s).)

Objective: We aim to explore the differences of the psychological distress of postoperative chemotherapy patients with colorectal cancer between mindfulness intervention combined with homogeneous medical concepts and mindfulness intervention only., Methods: One hundred patients with colorectal cancer undergoing chemotherapy after surgery from Sep 2020 to Sep 2022 were enrolled and divided into active control group (Solution centered nursing interventions; homogenized medical and nursing professional teams; dedicated personnel responsible for "admission notices"; Regular follow-up after discharge) and mindfulness group (homogeneous medical concept + and concentrated solution + Mindfulness intervention) with 50 cases in each group according to different nursing methods., Results: After nursing, the physical function, emotional function, cognitive function, and social function of the patients in the mindfulness group were significantly higher than those in the active control group. However, the overall life and economic difficulties of the patients in the mindfulness group were significantly lower than those in the active control group (P < 0.05). After nursing, the observation score, description score, action score, intrinsic experience score, non-judgment score and non-reaction score of the mindfulness group were significantly higher than those of the active control group (P < 0.05)., Conclusion: The implementation of mindfulness intervention in colorectal cancer patients undergoing chemotherapy can alleviate the patients' negative emotions, improve the level of mindfulness, and improve the quality of life of patients., (© 2024. The Author(s).)

Objective: This study aimed to investigate the effect of Pilates exercise on the quality of life, functional capacity, cancer-related fatigue, depression and salivary cortisol of colorectal cancer survivors., Methods: This is a quasi-experimental study which was conducted at Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia (UKM), and Hospital Al-Sultan Abdullah, Universiti Teknologi MARA (UiTM), Malaysia. The intervention group performed Pilates exercises with a certified Pilates instructor for eight weeks via online streaming from the participants' homes. Meanwhile, the control group participants received the usual care as stipulated by their oncologists. The primary outcome was the quality of life. The secondary outcomes were functional capacity, cancer-related fatigue, depression and salivary cortisol. Data was collected at baseline and eight weeks after the exercise intervention. The effects of the intervention were analyzed using Repeated Measures Analysis of Covariance (ANCOVA) statistical test., Result: Thirty-six (36) colorectal cancer survivors were allocated into either a Pilates exercise intervention group (N= 18) or a control group (N= 18). Over eight weeks, the Pilates exercise group revealed significant group x time interactions in terms of quality of life (p = 0.003), role functioning (p = 0.012), functional capacity (p = 0.048), and stool frequency (p = 0.021). However, only the stool frequency symptom (p = 0.008) remained significant after controlling for the confounders of age, gender and stage of cancer. No significant changes in cancer-related fatigue, depression and salivary cortisol levels between the groups were observed after the intervention., Conclusion: Pilates exercise had positive impacts on role functioning, bowel function, and functional capacity among colorectal cancer survivors, ultimately contributing to an improvement in quality of life.

Background: Colorectal cancer (CRC) is characterized by abnormal cancerous division of cells in the colon or rectum. Colorectal cancer (CRC) is the second most prevalent cause of cancer-related deaths worldwide. Therefore, this study aimed to assess awareness of colorectal cancer and its associated factors among adults in Bahir Dar City, Northwest Ethiopia, in 2023., Methods: A community-based, cross-sectional study was conducted in Bahir Dar City from April 17 to May 23, 2023. A total of 845 participants were selected using stratified multi-stage sampling. Interviewer administered questionnaire and validated cancer awareness Questionnaire were used to measure awareness of colorectal cancer in adults., Results: In this study, a total of 845 individuals were approached, and 839 participated, with a response rate of 99.2%. Out of 839 respondents, 314 (37.4%) of them had a high awareness of colorectal cancer. Being female (AOR (4.6) 95% CI (3.19-6.63), living in urban areas [AOR = 4.74; 95% CI (3.14-7.15)], educational level secondary school [AOR = 2.1 times; 95% CI (1.02-4.32)] and college and above [AOR =22.9; 95% CI (1.13-6.47)], and heard about colorectal cancer [AOR = 4.29; 95% CI (2.96-6.22)] had high awareness of colorectal cancer., Conclusion and Recommendation: The current study revealed that awareness of colorectal cancer was low. Sex, residency, level of education, and hearing about CRC, were associated factors of the awareness of CRC. Therefore, community-based education should be promoted about awareness of colorectal cancer.

Background: Disturbed sleep is frequently identified in adult patients with cancer and their caregivers, with detrimental impact on physical health. Less known is the extent to which self-reported and actigraph-measured sleep patterns are similar between patients and their sleep-partner caregivers, and how these different modes of sleep measurements are related to physical health., Methods: Patients diagnosed with colorectal cancer and their sleep-partner caregivers (81 dyads) completed a questionnaire for physical functioning and collected saliva samples for seven consecutive days, from which cortisol slope was quantified. Additionally, participants completed a daily sleep diary and wore actigraph for 14 consecutive days, from which sleep duration, sleep onset latency (SOL), and duration of wake after sleep onset (WASO) were calculated., Results: Participants reported sleep patterns that fell within or close to the optimal range, which were similar between patients and their caregivers. Self-reported and actigraph-measured sleep duration had moderate levels of agreement (ICC = 0.604), whereas SOL and WASO had poor agreement (ICC = 0.269). Among patients, longer self-reported WASO was associated with poorer physical health and flatter cortisol slope (p ≤ 0.013). Among caregivers, longer self-reported SOL was associated with poorer physical functioning, actigraph-measured WASO was associated with steeper cortisol slope, and longer self-reported sleep markers studied than actigraph-measured were associated with poorer physical functioning (p ≤ 0.042)., Conclusion: Findings suggest that employing multiple assessment modes for sleep and physical health is vital for comprehensive understanding of sleep health. Furthermore, when addressing patients' sleep health, it may be beneficial to include their sleep-partner caregivers who may experience similar disturbed sleep., (© 2024 The Author(s). Psycho‐Oncology published by John Wiley & Sons Ltd.)

Individuals with cancer are recommended to engage in regular physical activity (PA) even during cancer therapy. The aim of this study was to explore how patient-reported physician PA counseling influences their PA intention and behavior in addition to psycho-cognitive determinants derived from the theory of planned behavior (TPB). A longitudinal study during cancer treatment was conducted among N = 115 patients with breast, prostate, or colorectal cancer (M age  = 58.0, SD = 11.5; 55.7% female). The median time since diagnosis was 2 months, and 19.1% were diagnosed with metastases. Participants provided information on PA counseling by their physicians and on psycho-cognitive variables of the TPB at three measurement points. Additionally, they wore accelerometers for seven days at baseline and three months later. Nearly half of participants (48%) reported basic PA counseling and 30% reported in-depth PA counseling. Patients in poorer health and with lower education reported significantly less in-depth counseling. In addition to patient self-efficacy in performing PA, only in-depth physician PA counseling, but not basic physician counseling, predicted intention for PA four weeks later. Patients' PA three months after baseline was predicted by patients' PA at baseline and their intention for PA. Overall, the PA level at baseline was identified as the most important predictor of PA three months later. Nevertheless, physicians seem to have the ability to increase their cancer patients' intention for PA by in-depth counseling., (© 2023. The Author(s).)

Purpose: We examined colorectal cancer (CRC) risk perceptions among Black men in relation to socio-demographic characteristics, disease prevention factors, and personal/family history of CRC., Methods: A self-administered cross-sectional survey was conducted in five major cities in Florida between April 2008 and October 2009. Descriptive statistics and multivariable logistic regression were performed., Results: Among 331 eligible men, we found a higher proportion of CRC risk perceptions were exhibited among those aged ≥ 60 years (70.5%) and American nativity (59.1%). Multivariable analyses found men aged ≥ 60 had three times greater odds of having higher CRC risk perceptions compared to those ≤ 49 years (95% CI = 1.51-9.19). The odds of higher CRC risk perception for obese participants were more than four times (95% CI = 1.66-10.00) and overweight were more than twice the odds (95% CI = 1.03-6.31) as compared to healthy weight/underweight participants. Men using the Internet to search for health information also had greater odds of having higher CRC risk perceptions (95% CI = 1.02-4.00). Finally, men with a personal/family history of CRC were ninefold more likely to have higher CRC risk perceptions (95% CI = 2.02-41.79)., Conclusion: Higher CRC risk perceptions were associated with older age, being obese/overweight, using the Internet as a health information source, and having a personal/family history of CRC. Culturally resonate health promotion interventions are sorely needed to elevate CRC risk perceptions for increasing intention to screen among Black men., (© 2023. W. Montague Cobb-NMA Health Institute.)

Introduction: Qualitative research on the perceptions of healthcare professionals involved in cancer care about their respective roles in the patient care pathway is limited. Therefore, the aim of this qualitative study was to document these perceptions., Methods: A multidisciplinary team that included patient researchers constructed a semi-structured interview guide on the perceptions of the colorectal cancer care pathway by professionals. Interviews were conducted with healthcare professionals from two French hospitals that manage patients with colorectal cancer. Then, the interviews were fully transcribed and analysed by the whole multidisciplinary team., Results: Thirteen healthcare professionals were interviewed (six nurses, four physicians, one psychologist, one social worker and one secretary). They described the colorectal care pathway using a great lexical diversity and listed a significant number of professionals as taking part in this pathway. Among the people mentioned were healthcare professionals working inside and outside the hospital, family members and non-conventional medicine practitioners. However, they did not spontaneously mention the patient. Their views on the role of the referring physician, the general practitioner and the patient were further explored. The interviews highlighted the coordination difficulties among the various professionals, particularly between general practitioners and hospital teams. These data provided interesting elements for developing a tool to help coordination among professionals., Conclusions: This preliminary study, with its participatory design, brings interesting elements of reflection on the care pathway for patients with colorectal cancer. It will continue through the creation of a larger participatory project., Patient or Public Contribution: Patient partners were included in all steps of this study. This transdisciplinary project was coordinated by a group composed of three patient partners, two healthcare professionals and two humanities and social sciences researchers. Their knowledge of the patient's perspective on the care pathway enriched discussions from the study design to results analysis., (© 2024 The Author(s). Health Expectations published by John Wiley & Sons Ltd.)

Background: Concordance between a person's values and the test or treatment they ultimately receive is widely considered to be an essential outcome for good decision quality. There is little research, however, on why patients receive "discordant" care. A large, randomized trial of decision aids for colorectal cancer (CRC) screening provided an opportunity to assess why some patients received a different test than the one they preferred at an earlier time point., Methods: Of 688 patients who participated in the trial, 43 received a different CRC screening test than the one they selected after viewing a decision aid 6 mo prior. These patients answered 2 brief, open-ended questions about the reasons for this discordance. The research team analyzed their answers using qualitative description., Results: Patient responses reflected 6 major categories: barriers or risks of initially favored test, benefits of alternative test, costs or health insurance coverage, discussion with family or friends, provider factors or recommendation, and health issues., Conclusions: Some of the patients' explanations fit well with the informed concordance approach, which infers poor decision quality from the existence of discordant care, since in these cases it appears that the patient's values and preferences were not adequately respected. Other statements suggest that the patient had an informed rationale for changing their mind about which test to undergo. These cases may reflect high-quality decision making, despite the existence of discordance as measured in the trial. This analysis highlights a major challenge to a popular approach for assessing decision quality, the difficulty of normatively assessing the quality of decision making when apparent discordant care has been provided, and the need to assess patient values and preference over time., Highlights: Value-choice concordance is an accepted measure for assessing decision quality in decision aid trials, but greater exploration of apparently discordant care challenges key assumptions of this method; this study provides evidence that discordance as typically measured may not always reflect low-quality patient decision making.Researchers evaluating decision aids and assessing decision quality should consider the use of qualitative methods to supplement measures of decision quality and consider assessing patient preferences at multiple time points., Competing Interests: The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Support for JBR at the time of this submission was provided by the Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service; the views expressed in this article are those of the authors (JBR) and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government. The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The work for this study was conducted at the Indiana University School of Medicine. Support is provided by a Patient-Centered Outcomes Research Institute (PCORI) Award (CDR-1403-11040; PHS, KKS).

Introduction: Amidst the rising number of cancer survivors and personnel shortages, optimisation of follow-up strategies is imperative, especially since intensive follow-up does not lead to survival benefits. Understanding patient preferences and identifying the associated patient profiles is crucial. Coping style may be a key determinant in achieving this. Our study aims to evaluate preferences, identify coping styles and their associated factors, and explore the association between coping style and patients' preferences in colorectal cancer (CRC) follow-up., Methods: In a prospective multicentre implementation study, patients completed the Threatening Medical Situations Inventory (TMSI) to determine their coping style. Simultaneously patients choose their follow-up preferences for the CRC trajectory regarding frequency of tumour marker determination, location of blood sampling, and manner of contact., Results: A total of 188 patients completed the TMSI questionnaire after inclusion. A more intensive follow-up was preferred by 71.5% of patients. Of all patients, 52.0% had a coping style classified as 'blunting' and 34.0% as 'monitoring'. Variables such as a younger age, female gender, higher educational level, and lower ASA scores were associated with having higher monitoring scores. However, there were no significant associations between follow-up preferences and patients' coping styles., Conclusion: This study suggests that none of the provided options in a patient-led follow-up are unsuitable for patients who underwent curative surgery for primary CRC, based on coping style determined at baseline. Low-intensity surveillance after curative resection of CRC may, therefore, be suitable for a wide range of patients independent of coping styles., (© 2024. The Author(s).)

Background: More than 50% of colorectal cancer(CRC) patients experience cancer-related psychological burden after radical surgery, which can seriously affect their physical wellness, quality of life and even survival outcomes. Our research team developed a six-week Traditional Chinese Medicine Combined Online Group Psychotherapy (TCM-eRhab) and proved its efficacy on relieving cancer-related anxiety, depression and fear of cancer recurrence though phase I single arm clinical trial (n = 40). Large sample size randomized controlled clinical trial(RCT) is necessary to further evaluate TCM-eRhab's role on improving quality of life and survival outcomes among this population., Methods: We design a phase II RCT study, in which 210 CRC patients who have received radical surgery (stage I-III) will be recruited. Eligible patients will be randomly assigned to TCM-eRhab group or usual care group by 2:1 ratio. Patients in the intervention group will receive the structured TCM-eRhab program for six weeks, while patients in control group will receive usual care only. The primary outcomes are quality of life, severity of anxiety, depression and fear of cancer recurrence. Cancer recurrence rate will also be calculated according to long term follow-up data., Discussion: As one of the first RCTs to evaluate the impacts of TCM combined psychological therapy to improve CRC patients' quality of life after surgery, the results from this study will provide innovative knowledge and evidence on integrating TCM into CRC survivorship care and mind-body intervention model., (© 2024. The Author(s).)

Background: Colorectal cancer (CRC) is one of the few cancers for which screening has been associated with better survival and morbidity, but screening uptake has been underexplored in spouses of existing patients with CRC. The objective of this study was to evaluate whether a brief, structured behavioral intervention delivered to spouses of patients with CRC in a colorectal clinical setting could increase fecal immunochemical test (FIT) uptake within 3 months of the study period., Methods: This study was designed as a block randomized, unblinded, parallel trial conducted in the colorectal outpatient clinics of 2 public tertiary hospitals in Singapore from December 2017 to February 2023. The intervention group received a structured informational pamphlet on CRC screening by the Singapore Ministry of Health and a printed guide with instructions on how to properly use a FIT kit., Results: No significant differences in baseline characteristics were observed between the 2 groups. There was a statistically significant difference (P<.001) in FIT screening uptake between spouses in each group, with 86.2% (n=25) in the intervention group and 38.7% (n=12) in the control group., Conclusions: Our study demonstrated that a brief, structured behavioral intervention offered to spouses accompanying patients with CRC while they wait for the clinic appointment is useful in increasing FIT screening uptake rates. Colorectal clinics can consider setting aside 10 to 15 minutes to educate accompanying spouses in the future as a complementary avenue to holistically promote CRC prevention, subjected to the resources available in each clinic., Clinicaltrials: gov identifier: NCT04544852.

Purpose: Live-remote exercise interventions, supervised by exercise professionals in a home-based setting, could potentially enhance exercise accessibility for cancer survivors, yet research on their perspectives is limited. This study explored cancer survivors' experience of exercise within the context of a live-remote exercise intervention, to understand factors influencing exercise engagement., Methods: Four online focus groups with, in total, 22 breast, prostate, and colorectal cancer survivors were conducted between March and June 2023. These individuals had participated in a 12-week live-remote exercise intervention. The semi-structured discussions were transcribed verbatim and analysed using reflexive thematic analysis with an abductive approach. The Capability, Opportunity, Motivation model of Behaviour (COM-B) served as a supportive framework., Results: Nine themes were identified and mapped onto COM-B domains (capability, opportunity, motivation). Factors influencing cancer survivors' exercise engagement included exercise readiness following cancer treatment, bringing exercise closer, in capable hands, peer support through shared experience, life factors as hurdles or support, exercise as an integral component of cancer treatment, caring for myself and others after me, the positive impact of exercise exceeding expectations, and getting into the habit., Conclusions: Identifying factors shaping exercise engagement, these findings emphasise live-remote's potential benefit in overcoming barriers and fostering participation. Supervised by professionals, it offered psychosocial and exercise support, facilitating the integration of exercise into daily life., Implications for Cancer Survivors: Elucidating key factors for exercise engagement within a live-remote context is essential for developing and implementing live-remote exercise interventions to ensure accessible, integrated exercise for optimal post-treatment well-being for cancer survivors., (© 2024. The Author(s).)

Background: Significant concomitants of the sick role maladaptation in colorectal cancer (CRC) patients include inappropriate cognitions, emotional states, and overt conducts associated to disease. This protocol was developed to implement and evaluate the effects of a self-led, virtual reality-based cognitive behavioral therapy (VR-CBT) on the sick role adaptation among working-age CRC patients., Methods: This is an assessor-blinded, randomized controlled trail that adheres to the SPIRIT 2013 Statement guidelines. A total of 60 working-age CRC patients will be recruited from the colorectal wards of a cancer center and randomly assigned to the VR-CBT group or attention control (AC) group. The VR-CBT group will receive a 7-sessions VR-CBT targeted to sick role adaptation, while the AC group will receive weekly attention at the same time the VR-CBT group receives the intervention. The sick role adaptation, anxiety and depression, illness perceptions, and quality of life will be measured at baseline, 1, 2 and 3-month after completion of the intervention. Side-effects related to VR in the VR-CBT group will be measured at the end of each session. The participants will receive invitations to participate in semi-structured interviews to explore their experiences with the intervention., Discussion: The positive outcomes and user experience of VR-CBT will advance researches on the effectiveness of psychosocial interventions that aims to promote adaptation to the unexpected sick role on cancer populations. This protocol can be tested as an accessible and feasible alternative to traditional high-cost treatment in a randomized controlled study to improve the outcomes of younger cancer survivors., Trial Registration: The protocol was registered on 21 June, 2023 in Chinese Clinical Trial Registry (No.: ChiCTR2300072699) at https://www.chictr.org.cn/ ., (© 2024. The Author(s).)

Background: Colorectal cancer (CRC) is the second most deadly form of cancer, inducing an estimated 1.9 million incidence cases and 0.9 million deaths worldwide in 2020. Despite the availability of screening tests, their uptake remains suboptimal. However, blood-based tests that look for signs of cancer-specific markers in the body are increasingly available as an alternative for more invasive tests for cancer. Compared with existing tests, the benefits of blood-based tests for CRC include not needing pretest preparation, stool handling, and dietary or medication restrictions., Objective: This study aims to explore the population's preferences for CRC screening tests, with a focus on blood-based tests, and investigate the factors influencing test uptake., Methods: We used a mixed methods approach, combining semistructured interviews and a discrete choice experiment (DCE) survey. Interviews were analyzed using thematic analysis to identify salient attributes for CRC screening tests. These attributes informed the design of the DCE survey. The DCE data were analyzed using mixed logit and mixed-mixed multinomial logit models., Results: Qualitative findings from 30 participants revealed that participants preferred blood-based tests due to their perceived low risk, minimal pain, and ease of sample collection. However, concerns about the test's lower accuracy were also expressed. The DCE survey was completed by 1189 participants. In the mixed logit model, participants demonstrated a stronger preference for blood-based tests over a 2-day stool-based test. The mixed-mixed multinomial logit model identified 2 classes, strong supporters and weak supporters, for CRC screening. Weak supporters, but not strong supporters, had a higher preference for blood-based tests. Women, ethnic Chinese, and people aged 40 to 60 years were more likely to be weak supporters. Both models highlighted the high influence of cost and test sensitivity on participants' preferences. Transitioning from a 2-day stool-based test to a blood-based test, assuming a national screening program at a base price of Singapore $5 (US $3.75), was estimated to have the potential to increase the relative uptake by 5.9% (95% CI 3.6%-8.2%)., Conclusions: These findings contribute to our understanding of CRC screening preferences and provide insights into the factors driving test uptake. This study highlights the perceived advantages of blood-based tests and identifies areas of concern regarding their accuracy. Further research is needed to determine the actual increase in uptake rate when blood-based tests are made available., (©Clarence Ong, Alex R Cook, Ker-Kan Tan, Yi Wang. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org), 17.07.2024.)

This study investigated the influence of physical activity on the quality of life of patients with postsurgical colorectal cancer in Jordan. A total of 108 colorectal cancer patients aged ≥18 years who underwent surgery at the King Hussein Cancer Center participated voluntarily. The exclusion criteria were severe comorbidities, absolute contraindications to physical activity, and concurrent cancers. Data collection involved phone interviews using The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire and the Godin Leisure Time Exercise Questionnaire due to coronavirus disease 2019 restrictions. Significant positive differences in the quality of life subcategory "physical score" were observed between active and less active patients, favoring the active group. However, no significant differences were found in the impact of physical roles on quality of life between active and less active patients. Participation in physical activity is associated with enhanced physical function in both active and less active colorectal cancer patients. We recommend the implementation of physical activity programs and clinics at King Hussein Cancer Center. Future experimental studies assessing the impact of tailored physical activity training on quality of life are warranted., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Objectives: This study aimed to examine the mediating role of readiness for hospital discharge (RHD) and stoma self-efficacy (SSE) in the relationship between quality of discharge teaching (QDT) and health-related quality of life (HRQOL) in colorectal cancer patients with temporary enterostomy, and the gender difference of mediating effect., Background: It is not clear how RHD, QDT, SSE and HRQOL interact in colorectal cancer patients with temporary enterostomy., Methods: This was a prospective follow-up survey. 221 colorectal cancer patients with temporary enterostomy were conveniently recruited from a general hospital in Southeast China. The Quality of Discharge Teaching Scale, Readiness for Hospital Discharge Scale, Stoma Self-Efficacy Scale, and Stoma Quality of Life Scale were used to collect data. Pearson's correlation and structural equation models were used to analyze the data. SPSS 26.0 and Amos 28.0 software were used for analysis the collected data., Results: Regarding the relationship of QDT and HRQOL, only QDT-T had a direct effect among colorectal cancer patients with stomas (b = 0.233, P<0.001, percentile 95% CI = [0.145, 0.314]). However, both QDT-T and QDT-R can predict HRQOL indirectly through three paths: (1) the mediating role of SSE (b = 0.050, P = 0.009, percentile 95% CI = [0.013, 0.098]; b = 0.077, P = 0.008, percentile 95% CI = [0.021, 0.164]), (2) the mediating role of RHD (b = 0.044, P = 0.004, percentile 95% CI = [0.014, 0.085]; b = 0.044, P = 0.005, percentile 95% CI = [0.010, 0.102]), and (3) the chain mediating role of SSE and RHD (b = 0.030, P = 0.003, percentile 95% CI = [0.011, 0.059]; b = 0.047, P = 0.003, percentile 95% CI = [0.015, 0.103]). The similar chain mediating effect in male stoma patients was also found (b = 0.041, P = 0.002, percentile 95% CI = [0.016, 0.080]; b = 0.046, P = 0.004, percentile 95% CI = [0.011, 0.114])., Conclusions: Stoma self-efficacy and readiness for hospital discharge played important intermediary roles in the relationship between quality of discharge teaching and health-related quality of life in colorectal cancer patients with stomas. Health care providers can design SSE-enhancing and RHD-enhancing discharge planning for colorectal cancer patients with temporary enterostomies., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Lin et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Increased use of sphincter-preserving surgery following colorectal cancer has led to more people living with low anterior resection syndrome (LARS), a disordered bowel function that significantly impacts quality of life. Little is known about how patients experience the first months following sphincter-preserving surgery and having LARS., Objective: To shed light on what it means to live with LARS in the first three to six months after colorectal cancer sphincter-preserving surgery., Method: A qualitative study with a phenomenological approach constitutes the study design. Semi-structured interviews were conducted with five participants from September 2022 to January 2023. The transcribed interviews were analysed using Giorgi's phenomenological method., Results: Five themes emerged from the analysis: bowel emptying becomes all-consuming and affects both daily life and working life, you hear what they're saying, but don't understand what it means until your body goes through it, low anterior resection syndrome may impact sexual life, leaving feelings of guilt, it doesn't matter what the circumstances are, but rather how one deals with them, and support and follow-up from healthcare professionals, employers, family and friends are crucial for living a good life with LARS., Conclusion: Participants described struggles living with major LARS in the early period following hospital discharge. However, few months later, they had developed strategies enabling them to control their everyday life. Support and follow-up from healthcare professionals, employers, family, and friends were crucial when learning to live with major LARS. Participants expressed desire for a systematic and proactive follow-up from healthcare professionals and contact with peer-support groups., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Løvall et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objective: Control beliefs have been found to influence adaption to a cancer diagnosis. This study explored interrelationships among education, control beliefs, and health-related quality of life (HRQoL) in patients with breast, prostate, colorectal, and lung cancer and tested weather control beliefs act as mediators., Methods: Six hundred and five patients with breast (n = 205), prostate (n = 205), colorectal (n = 124), and lung (n = 71) cancer from two German cancer registries answered standardized questionnaires. Response rate was 54%. HRQoL was assessed with the EORTC QLQ-C30 core questionnaire and control beliefs (internal, external, and fatalistic) were evaluated using the IPC-questionnaire. Education was measured on a scale ranging from 1 to 8. Data were analyzed using multiple mediation models., Results: There was a positive correlation between education and HRQoL. Internal beliefs were positive and external beliefs were negative correlated with HRQoL. Internal control beliefs mediated the relationship between education and global health-related quality of life (.299, CI .122, .531), physical functioning (.272, CI .110, .486), emotional functioning (.325, CI .120, .578), and pain (-.288, CI - .558, - .094). External and fatalistic control beliefs did not act as mediators., Conclusion: Patients with low education feel they have less control over their cancer disease and consequently a poorer health-related quality of life., (© 2024. The Author(s).)

Background: The period between cancer diagnosis and surgery presents an opportunity for trials to assess the feasibility of behaviour change interventions. However, this can be a worrying time for patients and may hinder recruitment. We describe the perspectives of patients with excess weight awaiting colorectal cancer surgery about their recruitment into a randomised trial of a prehabilitation weight loss intervention., Methods: We interviewed the first 26 participants from the 8 recruitment sites across England in the 'CARE' feasibility trial. Participants were randomised into either usual care (n = 13) or a low-energy nutritionally-replete total diet replacement programme with weekly remote behavioural support by a dietitian (n = 13). The semi-structured interviews occurred shortly after recruitment and the questions focused on participants' recollections of being recruited into the trial. We analysed data rapidly and then used a mind-mapping technique to develop descriptive themes. Themes were agreed by all co-authors, including a person with lived-experience of colorectal surgery., Results: Participants had a mean body mass index (± SD) of 38 kg/m 2 (± 6), age of 50 years (± 12), and 42% were female. People who participated in the trial were motivated by the offer of structured weight loss support that could potentially help them improve their surgical outcomes. However, participants also had concerns around the potential unpalatability of the intervention diet and side effects. Positive attitudes of clinicians towards the trial facilitated recruitment but participants were disappointed when they were randomised to usual care due to clinical teams' overemphasis on the benefits of losing weight., Conclusions: Patients were motivated to take part by the prospect of improved surgical outcomes. However, the strong preference to be allocated to the intervention suggests that balanced communication of equipoise is crucial to minimise disappointment from randomisation to usual care and differential dropout from the trial., Clinical Trial Registration: ISRCTN39207707, Registration date 13/03/2023., (© 2024. The Author(s).)