The experiences of a structured pelvic floor rehabilitation program in colorectal cancer survivors with low anterior resection syndrome: A qualitative study

BACKGROUND: Low anterior resection syndrome (LARS) is a common survivorship challenge after colorectal cancer (CRC), affecting bowel function, psychosocial health, and daily living. Pelvic floor rehabilitation (PFR) is a supportive approach for bowel function recovery, but little is known about survivors' experiences of or behaviour change processes when participating in a structured PFR program. AIM: This study explored CRC survivors' experiences of LARS and structured PFR with focus on satisfaction, supportive care needs, and behaviour change processes. DESIGN: This was a cross-sectional qualitative study. Analysis employed a hybrid inductive-deductive approach to theme development and data mapping with Symptom Management Theory (SMT) and the COM-B model. SETTING/PARTICIPANTS: Fourteen participants with LARS who had completed the PFR program completed a self-administered paper satisfaction survey and semi-structured telephone interview. RESULTS: All participants rated their experiences as good to excellent on a 6-point Likert scale. Three themes related to participants' LARS experience and PFR program participation were generated: (1) living with unpredictable LARS; (2) a desire for quality information, timely education, and individualised multimodal support; and (3) regaining function and control through structured rehabilitation. Processes of behaviour change were as follows: (1) expectation management; (2) gaining ability to manage; (3) self-efficacy and habit consolidation; and (4) re-evaluation and relapse management. Mapping to SMT and COM-B informed development of a new model, the empowered behavioural adaptation process (EBAP). CONCLUSIONS: LARS imposes considerable physical and psychosocial burdens on CRC survivors, worsened by unmet informational needs and fragmented support. Behaviour change and self-management theories explain how guided, supportive care and individualised multimodal PFR through an empowered behavioural adaptation process, support self-efficacy and long-term management of LARS in CRC survivors.