INTRODUCTION: Wales has higher rates of bowel cancer incidence and mortality than other UK nations, with over 2300 new cases and 900 deaths annually. Regional disparities in bowel cancer mortality underscore the need for a better understanding of patient experiences of bowel cancer care in Wales as well as exploring potential areas for improvement. This evaluation aimed to explore the experiences of individuals with a history of bowel cancer and their caregivers in Wales, UK, examining diagnosis, treatment and aftercare. The study also explored patient and caregiver recommendations to inform potential improvements in service delivery, addressing the gaps in quality and accessibility of bowel cancer care across Wales. METHODS: This qualitative mixed-methods study used a combination of online surveys, interviews and focus groups to explore the experiences of individuals with bowel cancer and their caregivers in Wales. 71 survey responses were received, of which 23 individual interviews and 3 focus groups with 19 participants were conducted. Interviews and focus groups followed semistructured topic guides using a grounded theory methodology, with manual iterative coding of transcripts to identify themes and subthemes. SETTING: Focusing on people with a history of bowel cancer, and their caregivers, who had received bowel cancer care from the Welsh National Health Service. RESULTS: Thematic analysis of interview and focus group transcripts uncovered a central theme highlighting the role of effective communication in ensuring high-quality bowel cancer care. Four subthemes emerged from the data: (a) suspicion to diagnosis, which revealed barriers to early detection and the effects of miscommunication
(b) disparities and decision-making in treatment access, where geographic and socio-economic differences affected treatment and support options
(c) communication and coordination of care, emphasising gaps in the continuity of care
and (d) life after cancer, identifying unmet needs for sustained support post-treatment. Several potential areas for improvement to bowel cancer care in Wales were also suggested, including changes to bowel screening eligibility, empowering shared decision-making, tailoring support services for younger individuals with bowel cancer and improving aftercare support. CONCLUSIONS: This study highlighted a perceived 'postcode lottery' in bowel cancer care across Wales, with marked disparities between rural and urban areas. Findings advocate for targeted improvements to make care and support services more equitable and accessible across Wales.