Clinician and Patient Stakeholders Prioritize Rectal Prolapse Research Themes Through an International Delphi Process

BACKGROUND: – There is limited understanding on how to focus research and resources to enhance care for individuals with rectal prolapse. OBJECTIVE: – This study aimed to identify and prioritize clinical research themes for rectal prolapse with and without pelvic organ prolapse based on the perspective of clinician and patient stakeholders. DESIGN: – This IRB-approved (73560) study utilized the Delphi method (>70% consensus) with an initial open response survey followed by three subsequent iterative clinician survey rounds. A patient survey was adapted from the final consensus themes. SETTINGS: – Secure electronic data capture platform was used for online survey collection and an in-person consensus meeting was held at the 2024 Pelvic Floor Consortium. PARTICIPANTS: – Surveys were distributed through the Pelvic Floor Consortium volunteer list. MAIN OUTCOME MEASURES: – Three hundred seventy-two clinicians completed the first round and response rates were 69% and 64% for the second and third rounds, respectively. RESULTS: – The majority of respondents were colorectal surgeons (67%). 56% of clinician responders reported 10 or more years in practice and 47% had academic affiliations. Clinician responders were primarily from the United States (54%) and Europe (18%). Round one included 45 themes, 19 themes reached consensus at the end of round three. The consensus meeting included 146 clinician attendees and 13 themes were reconsidered during the meeting, three of which reached consensus. The final consensus comprised 22 themes which were adapted into a patient survey; twenty-six women (> 50 years) from the United States completed the survey. Ten themes reached consensus with all stakeholders with long-term functional outcomes reaching nearly unanimous agreement. LIMITATIONS: – Limitations include potential for clinician bias and lack of patient participation in the initial open-response survey design. CONCLUSIONS: – Through an iterative process we have identified a list of themes that can guide international collaboration on outcomes research over the next decade. See Video Abstract.