Development and formative evaluation of a follow-up checklist for patients who have undergone sphincter-preserving surgery for rectal cancer based on the Supportive Care Framework

Abstract

Objective

Rectal cancer survivors who have undergone sphincter-preserving surgery (SPS) face complex challenges often under-addressed by surveillance-focused guidelines. Grounded in the Supportive Care Framework—which emphasizes meeting patients’ holistic needs to improve outcomes—this study developed and evaluated a phase-specific follow-up checklist to standardize post-discharge management.

Methods

Using a mixed-methods design, an item pool was generated from a literature review (n = 18) and interviews (n = 19), mapped to the framework's four domains: physical, psychological, social, and informational. A two-round Delphi process (n = 15) refined the checklist. Consensus was reached through rigorous statistical validation of expert agreement. Finally, 12 patients and 7 nurses evaluated clinical acceptability and feasibility.

Results

Evidence synthesis highlighted gaps in physical function and psychosocial adaptation. Experts achieved high consensus, resulting in 52 items across four recovery phases. The checklist operationalizes tasks ranging from preventive stoma care and Low Anterior Resection Syndrome (LARS) management to social reintegration. Formative evaluation confirmed clinical utility and face validity, with an average nurse completion time of 22.7 minutes.

Conclusions

This theory-driven checklist complements surveillance guidelines by shifting focus to comprehensive survivorship care. It offers a structured workflow for the early detection of physical and psychosocial issues. Future research should prioritize multi-center psychometric validation and long-term effectiveness evaluation.