Quality standard
Quality statement 2: Discussion about treatment options for early rectal cancer
Quality statement 2: Discussion about treatment options for early rectal cancer
Quality statement
Adults with early rectal cancer discuss the implications of all potential treatment options with their healthcare professional. [new 2022]
Rationale
Transanal excision, endoscopic submucosal dissection and total mesorectal excision are potential treatment options for early rectal cancer. There are risks, benefits and possible implications on quality of life associated with each of these treatments. These should be discussed with their healthcare professional as well as personal preferences and practical factors before reaching a shared decision about the best option. A discussion about treatment options also offers the opportunity for adults with early rectal cancer to be given information on non-surgical procedures, the option of no treatment and participation in clinical trials.
Quality measures
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.
Structure
Evidence of availability of information to support discussions about all potential treatment options for adults with early rectal cancer.
Data source: No routinely collected national data for this measure has been identified. Data could be collected from information recorded locally by healthcare professionals, for example the availability of resources to help prepare for discussing options and making shared decisions. The National Bowel Cancer Audit organisational survey in 2022 will include a question at provider level on whether written information on different treatment options is provided to adults with rectal cancer.
Process
Proportion of adults with early rectal cancer who had a discussion about all potential treatment options with their healthcare professional.
Numerator – the number in the denominator who had a discussion about all potential treatment options with their healthcare professional.
Denominator – the number of adults with early rectal cancer.
Data source: No routinely collected national data for this measure in adults with early rectal cancer has been identified. Data can be collected from information recorded locally by healthcare professionals, for example from patient records. The National Cancer Patient Experience Survey includes a question that asks if treatment options were discussed with the person with colorectal cancer before cancer treatment started, but this is not limited to those with early rectal cancer.
What the quality statement means for different audiences
Service providers (such as secondary care services and specialist tertiary care services) ensure that staff are aware of all potential treatment options for early rectal cancer and are trained to discuss the implications of each treatment before they reach a shared decision with adults with early rectal cancer about the best option for them. Service providers ensure that adults with early rectal cancer have the option to be referred to another service provider if they do not offer a particular treatment option.
Healthcare professionals (such as colorectal cancer specialists) clearly explain all potential treatment options for early rectal cancer including endoscopic procedures, minimally invasive local surgical procedures and rectal resection. They give information on non-surgical procedures, the option of no treatment and relevant clinical trials. They discuss the implications of each of the options with adults with early rectal cancer before reaching a shared decision about the best option for them.
Commissioners (such as clinical commissioning groups, integrated care systems or NHS England) ensure that they commission services that can provide all potential treatment options for adults with early rectal cancer, including endoscopic and minimally invasive procedures, or have pathways in place to refer to other providers.
Adults with early rectal cancer have a discussion with their healthcare professional about all potential treatments, including no treatment, and are given information about procedures that do not need surgery. They feel informed to reach a decision about the best option for them.
Source guidance
Colorectal cancer. NICE guideline NG151 (2020, updated 2021), recommendations 1.2.2 and 1.3.1
Definitions of terms used in this quality statement
Early rectal cancer
Rectal cancer at stage cT1‑T2, cN0, M0. [NICE's guideline on colorectal cancer, recommendation 1.3.1]
Treatment options for early rectal cancer
Transanal excision including transanal minimally invasive surgery and transanal endoscopic microsurgery, endoscopic submucosal dissection or total mesorectal excision. [NICE's guideline on colorectal cancer, table 1]
Equality and diversity considerations
Adults with early rectal cancer should be provided with information that they can easily read and understand themselves, or with support, so they can communicate effectively with health and social care services. Information should be in a format that suits their needs and preferences. It should be accessible to those who do not speak or read English, and it should be culturally appropriate and age appropriate. Adults with early rectal cancer should have access to an interpreter or advocate if needed.
For people with additional needs related to a disability, impairment or sensory loss, information should be provided as set out in NHS England's Accessible Information Standard or the equivalent standards for the devolved nations.