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Review
. 2025 Mar 26;14(7):2255.
doi: 10.3390/jcm14072255.

Shared Decision Making in the Treatment of Rectal Cancer

Jonathan S Abelson  1 , Racquel S Gaetani  1 , Alexander T Hawkins  2
Affiliations
Review

Shared Decision Making in the Treatment of Rectal Cancer

Jonathan S Abelson et al. J Clin Med. .

Abstract

Background/Objectives: The management of locally advanced rectal cancer has evolved significantly, shaped by advances in multimodal neoadjuvant therapy and a growing emphasis on organ preservation through the watch-and-wait approach. These advancements, however, introduce complex treatment decisions that require careful consideration by both patients and clinicians. Methods: This narrative review explores the evolution of the management of locally advanced rectal cancer and the role of shared decision-making in guiding treatment decisions, particularly for patients facing decisions between surgical resection and watch-and-wait. Additionally, it discusses the development of tools to aid in shared-decision making, current challenges in implementing shared decision-making and future directions for improvement patient centered care in locally advanced rectal cancer management. Results: Considerations for decision making include anatomical considerations that influence surgical options, the potential benefits and risks of watch-and-wait versus surgical resection of the rectum, and the impact of treatment on bowel, urinary, and sexual function. Additionally, patients must weigh the long-term implications of their choices on quality of life. Conclusions: Shared decision-making has emerged as a critical component of patient-centered care and ensures that treatment decisions align with patients' values and priorities. Given the preference-sensitive nature of the management of locally advanced rectal cancer, shared decision-making plays an important role in helping patients navigate these decisions.

Keywords: abdominoperineal resection; bowel function; locally advanced rectal cancer; low anterior resection; nonoperative management; patient decision aid; quality of life; shared decision making; watch & wait.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Treatment decisions in the management of locally advanced rectal cancer.
Figure 2
Figure 2
Treatment decisions in the management of early-stage rectal cancer.
See this image and copyright information in PMC

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