Moon Andrew M, Richardson Daniel, Lupu Gabriel V, Evon Donna M, Sanoff Hanna K, Carda-Auten Jessica, Teal Randall, Waheed Myra, Basch Ethan, Mauro David M, Yanagihara Ted K, Gerber David A, Shah Neil D, Fix Oren K, Shroff Hersh, Triglianos Tammy, Sorah Jonathan D, Jia Jingquan, Somasundaram Ashwin, Wagner Lynne I, Kappelman Michael D, Schooler Matthew, Phillips Julia R, Ekuban Hiwot A, Sanderford Ariel E, Barritt A Sidney
Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA.
Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA.
MDM Policy Pract. 2025 May 29;10(1):23814683251340055. doi: 10.1177/23814683251340055. eCollection 2025 Jan-Jun.
Hepatocellular carcinoma (HCC) treatment decisions are becoming increasingly complex as new treatment options emerge. Improved understanding of tradeoffs and patient preferences in treatment decisions will enhance patient-provider discussions, improve treatment development, and inform HCC treatment guidelines. We performed a qualitative study involving patients with HCC and medical providers to assess the role of patient preferences in HCC treatment choices. Patient participants included those with HCC seen within a single tertiary care center. Provider participants involved physicians and advanced practice providers who cared for patients with HCC from a single center. Baseline and posttreatment patient interviews were conducted by trained qualitative research experts, informed by semi-structured interview guides, and analyzed using thematic analysis with pilot-tested codebooks. Summaries included a narrative description of the themes and subthemes that emerged related to each code, and illustrative quotes were used to highlight each theme. The baseline interview involved 30 patients with HCC (22 of whom participated in follow-up interviews) and 10 providers who cared for patients with HCC. Patients identified factors considered when making treatment decisions included provider confidence and experience, patient prior cancer experiences, other health issues, and faith. Providers primarily discussed the role of Barcelona Clinic Liver Cancer stage, liver function, performance status, and eligibility of liver transplantation in making treatment recommendations. There was general agreement among providers that there is a need to better understand the role of patient values to improve care for HCC. Qualitative interviews were limited to patients and providers from a single center. This qualitative study provided information on the variety of values considered by both patients and providers in HCC treatment decisions and the importance of considering tradeoffs of efficacy, toxicity, and inconvenience/costs.
Hepatocellular carcinoma (HCC) treatment decisions are often complex and may become increasingly so as new treatment options emerge.Improved understanding of tradeoffs and patient preferences in treatment decisions will enhance patient-provider discussions, facilitate patient-centered trials to develop new treatments, and inform HCC treatment guidelines.This qualitative study of patients and providers provided information on the values considered in HCC treatment decisions and the importance of considering the tradeoffs of efficacy, toxicity, and inconvenience/costs.These insights can be used to develop preference elicitation tools, perform large-scale preference elicitation surveys, and systematically assess and incorporate patient preferences into treatment decisions.
随着新的治疗选择不断涌现，肝细胞癌（HCC）的治疗决策变得日益复杂。更好地理解治疗决策中的权衡和患者偏好，将加强医患之间的讨论，改善治疗方案的制定，并为HCC治疗指南提供参考。我们开展了一项定性研究，涉及HCC患者和医疗服务提供者，以评估患者偏好在HCC治疗选择中的作用。患者参与者包括在一家三级医疗中心就诊的HCC患者。医疗服务提供者参与者包括来自同一中心、负责治疗HCC患者的医生和高级执业提供者。由经过培训的定性研究专家依据半结构化访谈指南对患者进行基线访谈和治疗后访谈，并使用经过预测试的编码手册进行主题分析。总结内容包括对与每个编码相关出现的主题和子主题的叙述性描述，并使用示例引语来突出每个主题。基线访谈涉及30例HCC患者（其中22例参与了随访访谈）以及10名负责治疗HCC患者的医疗服务提供者。患者确定的治疗决策考虑因素包括医疗服务提供者的信心和经验、患者既往癌症经历、其他健康问题以及信仰。医疗服务提供者主要讨论了巴塞罗那临床肝癌分期、肝功能、体能状态以及肝移植资格在提出治疗建议中的作用。医疗服务提供者普遍认为有必要更好地理解患者价值观的作用，以改善HCC的治疗。定性访谈仅限于来自单一中心的患者和医疗服务提供者。这项定性研究提供了有关患者和医疗服务提供者在HCC治疗决策中所考虑的各种价值观，以及考虑疗效、毒性和不便/成本权衡的重要性的信息。
肝细胞癌（HCC）的治疗决策通常很复杂，随着新的治疗选择出现，可能会变得愈发复杂。更好地理解治疗决策中的权衡和患者偏好，将加强医患之间的讨论，推动以患者为中心的试验以开发新的治疗方法，并为HCC治疗指南提供参考。这项针对患者和医疗服务提供者的定性研究提供了有关HCC治疗决策中所考虑的价值观，以及考虑疗效、毒性和不便/成本权衡的重要性的信息。这些见解可用于开发偏好诱导工具、开展大规模偏好诱导调查，并系统地评估患者偏好并将其纳入治疗决策。
