Quantifying Patient Risk Threshold in Managing Pancreatic Intraductal Papillary Mucinous Neoplasms

Area of Science:

• Gastroenterology
• Surgical Oncology
• Medical Decision Making

Background:

• Management of intraductal papillary mucinous neoplasms (IPMNs) is complex.
• Aligning treatment decisions with patient preferences is an area for improvement.

Purpose of the Study:

• To understand patient treatment preferences for incidentally identified IPMNs.
• To quantify the cancer risk threshold at which preferences shift.
• To inform patient counseling and shared decision-making.

Main Methods:

• Survey of 520 healthy volunteers simulating incidental IPMN diagnosis.
• Assessed treatment preference (surgery vs. surveillance) at 5% cancer risk.
• Quantified individual cancer risk thresholds for treatment change.
• Measured cancer anxiety using a 5-point Likert scale.
• Used multivariable linear regression to analyze associations.

Main Results:

• Median risk threshold was 25%, with a bimodal distribution.
• At 5% risk, 62% preferred surveillance, 38% preferred surgery.
• Higher cancer anxiety correlated with significantly lower risk thresholds.

Conclusions:

• Significant variability exists in IPMN treatment preferences and risk thresholds.
• Patient anxiety about malignancy influences their risk threshold.
• Understanding patient-specific risk thresholds is key for shared decision-making in IPMN management.