218 Chapter 10 risk assessment for AL, including a comprehensive discussion with each patient to ensure they are fully informed. Lack of preparation for a potential stoma was another issue identified in our study. As a result, two stoma-related reporting elements were included in the preoperative assessment: (1) whether potential need for a postoperative or permanent stoma was discussed, and (2) whether the patient received preoperative education about a possible stoma. To better capture the occurrence and impact of short- and long-term sequelae of AL, we included the reporting of all complications related to AL (e.g., hernia, stricture, fistula, stoma complications) in the early and late phases of the framework, respectively. Finally, to address the impact of AL on function and QoL, we integrated the LARS score 41, Wexner Fecal Incontinence Score 42, and QoL measures in the early and long-term phases of the framework. The framework includes follow-up on all emotional and physical outcomes for at least one year. Strengths, limitations and future perspectives We used a robust qualitative approach to gain insights into the physical and emotional burdens experienced by patients with an AL. While this study included a diverse group of participants, highlighting a range of perspectives, the number of participants included was small. However, unlike quantitative studies, qualitative studies do not aim for generalizability based on sample size but strive for plausibility based on thematic saturation. The researchers’ comprehension and interpretation of the data could have influenced the results. To mitigate this, two trained researchers independently coded the data and themes were discussed with the larger research team. The possibility of socially desirable responses regarding treatment satisfaction or the omission of sensitive issues cannot be ruled out. Nevertheless, interviews were conducted without prior clinical associations with participants. Lastly, respondent validation (i.e., member checking) was not performed, but the rigorous application of thematic analysis ensured that interpretations remained closely aligned with participants’ perspectives as expressed in the interviews. This initial exploration could guide future research involving a larger, more diverse patient population worldwide. Within future research and the use of the CoReAL framework, it may also be beneficial to compare patient perceptions according to the grade of AL 43. Yet, this study may serve as a foundation for creating a universally accepted questionnaire for patient-reported outcomes (PROs).
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