Development of S.Tool: An electronic diary for assessing bowel symptoms after rectal cancer surgery

Abstract

Introduction: Rectal cancer treatment has improved survival, but postoperative bowel dysfunction, known as Low Anterior Resection Syndrome (LARS), significantly impacts Quality of Life. However, current assessment tools lack granularity to assess all LARS symptoms. Therefore, this study developed a mobile application (S.Tool), designed to be patient-friendly and easy to interpret, tailored to monitor LARS. Materials and methods: This study followed eight phases: 1) literature review, 2) internal expert group, 3) pre-Delphi patient focus group, 4) international Delphi Survey (conducted in two rounds in Dutch and English with five stakeholder-groups including colorectal surgeons, radiation and medical oncologists, pelvic floor physiotherapists, colorectal clinical nurse specialists and patients), 5) post-Delphi patient focus group, 6) consensus meeting, 7) forward-backward translation, and 8) development of the application. Descriptive statistics, percentages and median (range), were used to present the data. Results: A total of 122 participants, including 22 patients, participated in the international Delphi survey. Of these, 103 (84%) completed the first round and 97 (80%) the second round. After the Delphi rounds, 25 items were included in the bowel diary, 10 excluded and 8 discussed in the consensus meeting. Based on feedback from the post-Delphi patient focus group, the consensus meeting decided to include 6 of the 8 discussed items, resulting in 31 items. These guided the development of the S.Tool application. Conclusion: The S.Tool application is an innovative, multidisciplinary bowel diary for assessment and follow-up of patients with LARS. It generates visual summaries shareable with healthcare professionals to support clinical decision-making and personalized care.