Decision-making processes among patients with lung cancer considering participation in neoadjuvant immunotherapy...

As neoadjuvant immunotherapy becomes increasingly incorporated into clinical trial protocols for lung cancer, patients are required to make complex decisions under conditions of uncertainty. However, the dynamic processes underlying their decision-making remain insufficiently understood.

A qualitative study informed by grounded theory methodology was conducted at the Clinical Trial Center of the Cancer Hospital, Chinese Academy of Medical Sciences. In-depth, semi-structured interviews were performed with 16 patients with lung cancer who were undergoing neoadjuvant immunotherapy within clinical trials. Data were analyzed using open, axial, and selective coding to construct a theoretical model of the decision-making process.

The decision-making process evolved through five interrelated phases: initiation, deliberation and trade-off, commitment formation, adjustment, and post-decision evaluation. Decision-making satisfaction was shaped by both internal factors (e.g., personal beliefs, perceived risk tolerance, treatment expectations) and external influences (e.g., physician communication, family involvement, trial-related information).

We developed a grounded theoretical model describing how patients with lung cancer navigate decisions regarding participation in neoadjuvant immunotherapy clinical trials. The findings highlight the need for stage-specific and culturally sensitive decision support strategies delivered by clinical research teams. Addressing both internal and contextual determinants may enhance decision quality and satisfaction among treatment-naïve patients considering trial participation.