Investigation of knowledge, attitudes and practices regarding prevention of low anterior resection syndrome in rectal cancer patients with prophylactic stoma: a multicenter cross-sectional study

[Objectives] To investigate the current status of knowledge, attitudes and practices regarding prevention of low anterior resection syndrome in rectal cancer patients with prophylactic stoma and analyze influencing factors. [Methods] A multicenter cross-sectional study was conducted from January 2024 to January 2025 across 20 tertiary hospitals in Beijing, Tianjin, and Hebei. Patients undergoing stoma reversal after sphincter-preserving surgery with prophylactic stoma for rectal cancer were enrolled. Data were collected using a general information questionnaire and a validated knowledge, attitudes and practices questionnaire for low anterior resection syndrome. [Results] Among 206 patients, the total score of knowledge, attitudes and practices for low anterior resection syndrome prevention was (109.4±20.3), with sub-scores of [(38.5±8.5), 64.1% scoring rate] for knowledge, [(40.0±4.3), 80% scoring rate] for attitudes, and [(30.9±10.6), 61.8% scoring rate] for practices. Univariate analysis revealed the scores of knowledge, attitudes and practices for low anterior resection syndrome prevention were statistically significant different among rectal cancer patients with prophylactic stoma in terms of different education level, residence, occupation, comorbidities, primary caregiver, stoma-related complications, and stoma duration (P<0.05). There was no statistically significant difference in the scores of knowledge, attitudes and practices for low anterior resection syndrome prevention among rectal cancer patients with prophylactic stoma with the remaining demographic characteristics (P>0.05). Multivariate analysis identified education level, residence, and primary caregiver as independent predictors of knowledge, attitudes and practices level regard- ing prevention of low anterior resection syndrome in rectal cancer patients (P<0.05). Pearson correlation analysis showed positive associations between knowledge and attitudes (P<0.001), knowledge and practices (P<0.001), and attitudes and practices (P<0.001). Attitudes partially mediated the relationship between knowledge and practices, accounting for 24.3% of the total effect. [Conclusion] Rectal cancer patients with prophylactic stoma exhibit suboptimal knowledge and practices but positive attitudes toward low anterior resection syndrome prevention. Attitudes partially mediate the knowledge-practice relationship. Healthcare providers should prioritize patient-centered education, strengthen positive attitudes, and leverage knowledge to motivate health-promoting behaviors.