Patient-centered valuation of minimally invasive surgery in cervical cancer: a discrete choice experiment

초록

Objective: Although minimally invasive surgery (MIS) for cervical cancer is consideredinferior to open surgery, many patients still prefer MIS, and their preferences regardingsurgical options remain underexplored. Understanding how patients value surgicalprocedures is essential for informed, patient-centered decision-making. Methods: A discrete choice experiment was conducted with 131 gynecologic cancer patientsvia face-to-face surveys from January 2023 to July 2023. The 6 attributes of MIS evaluatedwere hospital stay length, time to return to normal activities, serious surgical complications,cosmetic outcomes, 3-year overall survival (OS), and cost. Results: Except for hospital stay length, the remaining 5 attributes—3-year OS (oddsratio [OR]=0.30; 95% confidence interval [CI]=0.22–0.43; p<0.001), out-of-pocket costs(OR=0.60; 95% CI=0.47–0.77; p<0.001), serious surgical complications (OR=0.67; 95%CI=0.57–0.79; p<0.001), cosmetic outcomes (OR=0.68; 95% CI=0.59–0.79; p<0.001), andtime to return to normal activities (OR=0.71; 95% CI=0.61–0.82; p<0.001)—significantlyinfluenced decision-making. The likelihood of choosing a procedure increased by 3.3-fold with a 5% improvement in OS, followed by a 1.4-fold increase with fewer seriouscomplications, better cosmetic outcomes, or a faster return to normal activities. Patientsunder 50 valued survival, lower costs, cosmetic outcomes, and quicker recovery more thanolder women, who placed greater emphasis on minimizing serious complications. Conclusion: Patients prioritized survival outcomes, while other non-oncologicMIS characteristics were also important. Incorporating patients’ preferences and understandingage-related changes is essential for effective shared decision-making in clinical practice.

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