213 The patient perspective on colorectal anastomotic leaks: A qualitative study clear that AL initially impacted patients’ QoL, but the longer-term impact was generally minor. One participant noted increased anxiety about returning to the hospital in general, which she attributed to her extensive AL treatment (P10). While participants experienced both emotional and physical limitations in the initial recovery period, most participants accepted the situation and adapted. Coping strategies Participants described how they navigated the physical and emotional challenges associated with the AL continuum. Many adopted an optimistic outlook, trying to stay positive throughout the diagnosis and treatment despite the pain (P8). Participants emphasized the importance of accepting their ‘new normal’, putting their disease into perspective, and moving on with their lives. While some found comfort in having undergone curative resection despite the AL, one participant with metastatic disease (P2) noted that fixing the leak did not aid recovery as the cancer persisted. Participants emphasized the crucial role of a support system including surgeons, nurses, stoma specialists, and other related health care professionals, and appreciated receiving information about their ongoing treatment. Support from family, friends, and patient support groups helped with coping. Some participants also found relief in their spiritual beliefs. Important elements of AL care Participants were asked to reflect on their experience to identify important elements of AL care of which seven were identified (Figure 1 and illustrative quotes in Table 3). First, participants felt that sharing all‐encompassing and detailed information about possible postoperative complications before surgery was essential. They recommended that healthcare professionals provide patients with more information regarding the symptoms that would raise suspicion for AL in the early postoperative period. This may help patients recognize the signs of AL earlier and seek medical attention sooner. Second, honest, transparent, compassionate, and clear communication during the whole journey was highlighted as a very important factor. Third, some participants felt that the amount of information received and the way it was presented at the time of AL diagnosis was overwhelming. One participant endorsed that the most difficult time for them was during the initial phase in hospital as they felt very ill and were not sleeping well due to the environment (i.e., multiple visits from medical team, equipment alarms). Fourth, the use of case managers throughout the recovery period to help patients navigate the care continuum was emphasized. Fifth, medical staff support was highlighted as very critical during this time. Sixth, participants stressed the importance of adequate nursing and social support. They recommended that patients receive postoperative information and resources for additional social and peer support. Also, the importance of timely referral to stoma and/or physical therapists for comprehensive aftercare was emphasized. Finaly, participants appreciated being involved in the decisionmaking process regarding management options (shared decision making). 10
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