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.