"What's a Win": A Qualitative Study Exploring Surgeon Perspectives on Operative Intent in Non-curative Cancer Surgery

To explore surgeons' perspectives on and priorities for communicating about non-curative operations for patients with advanced cancers, which aim to improve longevity or quality of life without possibility of cure.

Describing the potential benefits of non-curative surgery is important so that treatment decisions are based on an accurate understanding of what surgery can achieve. However, surgeons' perspectives on and practices for communicating non-curative operative intent with patients are not known.

This qualitative study involved semi-structured interviews with cancer surgeons who were recruited throughout the U.S. through purposive and snowball sampling. Interviews included discussions around two case scenarios describing non-curative operations. We explored participants' perspectives and communication preferences through the scenarios. Thematic analysis was completed using an inductive approach.

We interviewed 18 surgeons from 16 institutions with varying years of practice. Surgeons framed the overarching goal of non-curative surgery as preventing disease progression, with the more specific goals of living longer and living better. Additionally, participants underscored the prognostic uncertainty about the disease trajectory of advanced cancer, compounded by limited evidence to guide decisions about non-curative surgery. This uncertainty informs surgeons' communication priorities to 1) clarify treatment intent and 2) disclose their uncertainty, ultimately aiming to establish alignment with their patients.

This study delineated an existing paradigm for discussing the goals of non-curative surgery for advanced cancer, and also highlighted the role that prognostic uncertainty plays in cancer surgeons' communication practices.