Enhancing decision-making and patient comprehension in complex rectal cancer surgery through personalized three-dimensional imaging: randomized feasibility study.

BACKGROUND

Shared decision-making is essential for patient autonomy in complex rectal cancer requiring pelvic exenteration. Patients often lack understanding of procedures and risks, causing decisional conflict. Personalized three-dimensional (3D) models may improve patient education and decision-making.

METHODS

A single-centre mixed-methods randomized feasibility trial was conducted at St Mark's Complex Cancer Clinic (June 2021-March 2022). Patients referred for pelvic exenteration were randomized 1 : 1 to standard consultation or standard consultation plus personalized 3D modelling. The primary qualitative objective explored patient engagement with 3D models through semi-structured interviews. The primary quantitative outcome assessed changes in decisional conflict scale (DCS) scores. Secondary outcomes included operative knowledge questionnaires and patient-surgeon agreement on functional outcomes.

RESULTS

Qualitative analysis showed that personalized 3D models enhanced patient understanding of complex anatomy, built trust, improved communication, and facilitated emotional processing. Quantitatively, a greater reduction occurred in DCS scores post-consultation in the 3D group (29 patients) compared with the standard group (22 patients) (median reduction of 36 versus 14 points; P = 0.005), though baseline scores differed. The 3D group demonstrated higher patient-surgeon agreement on functional outcomes (84% versus 60%; P < 0.001), despite greater operative complexity (median Pelvic Exenteration Lexicon score of 8 versus 4.5; P = 0.040).

CONCLUSION

This feasibility study suggests that personalized 3D models may enhance comprehension and reduce decisional conflict in complex rectal cancer consultations. However, baseline differences between groups and lack of comparison with generic models limit definitive conclusions. Future research should address these methodological limitations and explore longer-term outcomes, such as decisional regret.