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

Although minimally invasive surgery (MIS) for cervical cancer is considered inferior to open surgery, many patients still prefer MIS, and their preferences regarding surgical options remain underexplored. Understanding how patients value surgical procedures is essential for informed, patient-centered decision-making.

A discrete choice experiment was conducted with 131 gynecologic cancer patients via face-to-face surveys from January 2023 to July 2023. The 6 attributes of MIS evaluated were hospital stay length, time to return to normal activities, serious surgical complications, cosmetic outcomes, 3-year overall survival (OS), and cost.

Except for hospital stay length, the remaining 5 attributes-3-year OS (odds ratio [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), and time to return to normal activities (OR=0.71; 95% CI=0.61-0.82; p<0.001)-significantly influenced 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 serious complications, better cosmetic outcomes, or a faster return to normal activities. Patients under 50 valued survival, lower costs, cosmetic outcomes, and quicker recovery more than older women, who placed greater emphasis on minimizing serious complications.

Patients prioritized survival outcomes, while other non-oncologic MIS characteristics were also important. Incorporating patients' preferences and understanding age-related changes is essential for effective shared decision-making in clinical practice.