Decision-making and peri-operative perspectives of patients with advanced cancer who have decided for and proceeded with palliative gastrointestinal surgery: A qualitative study.

BACKGROUND: Palliative gastrointestinal surgery improves symptoms and health-related quality of life among patients with advanced cancer who present with bowel obstruction. However, there remains limited understanding on decision-making surrounding palliative surgery, particularly risks and implications for patients near end-of-life. OBJECTIVES: This study aims to explore the perspectives of patients who have decided and proceeded with Palliative Gastrointestinal Surgery across the perioperative period, including considerations that shaped decision-making for palliative gastrointestinal surgery, challenges in decision-making, and subsequent post-surgery experiences in patients with advanced cancer. METHODS: We conducted qualitative in-depth interviews with 25 purposively sampled patients with advanced stage IV cancer, who had underwent palliative gastrointestinal surgery for malignant bowel obstruction. Interviews were transcribed verbatim and thematically analysed. RESULTS: There were four key considerations that shaped patients' decision for palliative gastrointestinal surgery. They included the hopes for return to normalcy and symptomatic relief, trust in surgeons and communication, religious beliefs, and familial pressures and support. Misunderstandings about treatment options and achievable outcomes after surgery, and the need to navigate fears and anxiety due to the uncertainties surrounding surgery were the main challenges encountered during decision-making. Post-surgery, while most were satisfied with their decision to undergo surgery, some faced decisional regret due to new or heightened care needs associated with ongoing cancer progression. CONCLUSION: Decision-making for palliative gastrointestinal surgery is complex, with patients weighing a range of considerations. Challenges include misunderstandings on options and outcomes and navigating uncertainties. These challenges highlight opportunities to improve patient care through improved communication and the provision of emotional support.