'Everyone has their own way-there's no protocol'. An Australian qualitative study of clinician perspectives on the management of low anterior resection syndrome.

Abstract

To identify clinicians' perceived challenges and barriers in the management of low anterior resection syndrome (LARS) through exploration of attitudes and decision-making practices around screening, diagnosis and management. Exploratory interpretive qualitative design. Semi-structured interviews were undertaken and a reflexive thematic qualitative analysis was conducted using an iterative-inductive approach. Eleven colorectal surgeons, six physiotherapists and three specialist nurses were interviewed. Data were grouped into four major themes and 13 sub-themes. Variation in clinician engagement with LARS was identified, with clinicians' knowledge, training and personal interest in managing patients raised by participants as contributing factors. An absence of standardized management pathways presented challenges in clinical practice with the lack of structured multidisciplinary approaches and referral pathways combined with a perceived lack of established treatment guidelines impacting on clinical decision-making. Inequities in access to specialist pelvic services and treatment were identified as systemic limitations which influence clinical decision-making in relation to clinical practice and implementation of patient care. The interpretation of the patient experience with LARS and perceptions of treatment acceptability were identified to influence clinical decision-making and demonstrated divergent perceptions of patient experience. This study identified several challenges in LARS management from a clinician's perspective. A lack of standardized treatment guidelines and pathways, limited treatment access, and inconsistent clinician engagement present challenges. Divergent perceptions of patient experience and treatment acceptability further complicate care. These findings highlight the urgent need to address these systemic limitations through enhanced surgeon education, standardized treatment/referral guidelines, improved patient resources and expanded access to multidisciplinary care.