Decision-Making and Decision Satisfaction Following Cytoreductive Surgery and HIPEC for GI Malignancies: A Qualitative Study.

Abstract

For patients with aggressive gastrointestinal malignancies, cytoreductive surgery and heated intraperitoneal chemotherapy (CRS/HIPEC) offers a chance for prolonged survival but comes with risks of morbidity, decreased quality of life, and-rarely-death. Decision-making for patients considering CRS/HIPEC is complex and understudied. This study explored how patients approached the decision to pursue CRS/HIPEC and how they perceived their decisions postoperatively. We performed a qualitative study with patients who underwent CRS/HIPEC between May 2023 and March 2024. Patients were interviewed using a semi-structured interview guide focused on understanding the decision-making process around CRS/HIPEC and assessing whether patients experienced decision regret after surgery. Transcripts were analyzed inductively using the constant comparative method. In total, 14 of 18 patients completed interviews at a median of 16.9 months after CRS/HIPEC (median age 57 years; 50% women). We identified four key themes, which focused on patient sources of information about CRS/HIPEC, preoperative conversations about CRS/HIPEC, the decision-making-process, and decision satisfaction versus decision regret. Most patients felt they had little agency in the decision to pursue CRS/HIPEC but were trusting of their providers' recommendations. Decision regret was uncommon and most associated with recurrent disease when present. Patients placed high value on their disease-free interval and time away from chemotherapy. This study offers an improved understanding of the decision-making process for patients pursuing CRS/HIPEC. Surgeons can use these data to improve preoperative counselling. Future quality-of-life studies should include questions to determine the value of chemotherapy-free intervals.