Patient Expectations in High-Risk Abdominal Surgery for Cancer

Despite the central role of expectations in informed consent and surgical shared decision-making, patient expectations frequently remain unelicited or underexplored and are often assumed rather than explicitly addressed.

To explore how patients form expectations about high-risk abdominal surgery for cancer and how preoperative expectations influence the experience of surgical recovery and life after surgery.

Qualitative study using semi-structured interviews informed by cognitive task analysis and analysed using an abductive thematic framework.

Adults (n = 34) at two U.S. academic hospitals who were either scheduled to undergo, or had recently undergone, high-risk abdominal surgery for cancer; interviews were conducted preoperatively (52.9%) and postoperatively (47.1%).

Analysis of the interviews revealed three overarching themes characterising how patients formed, understood, and experienced expectations around high-risk cancer surgery. Theme 1: Origin of Expectations- Expectation development was dynamic, context-dependent, and shaped by multiple information sources. Theme 2: The Complexity of Expectations- Patients varied widely in how much they wanted to know; expectations were often internally inconsistent and frequently conflated with hopes. Theme 3: Contrasting Anticipated and Actual Recovery After Surgery- Postoperative experiences commonly diverged from preoperative expectations, and many patients expressed uncertainty regarding recovery and prognosis, even in medically uncomplicated recoveries.

The wide variation and inconsistency in patient expectations reflect both the complexity of how patients prepare for high-risk abdominal cancer surgery and their need to navigate uncertainty in ways that align with their individual preferences, values, and tolerance for information. Mismatches between anticipated and actual postoperative experiences underscore the need for structured, patient-centred communication strategies that support realistic preparation for surgical recovery.

This study provides insight into how patients with cancer form expectations regarding high-risk abdominal surgery and how these expectations shape preparation for the experience of surgical recovery. Expectations were often incomplete, internally inconsistent, and difficult for patients to articulate, contributing to gaps between anticipated and actual recovery. These findings highlight the need for intentional, patient-centred approaches to elicit, clarify, and better align patient and clinician expectations in surgical oncology. Future work should evaluate intervention strategies to support this goal.

Patients participated in in-depth interviews that form the basis of this study. Caregiver interviews were conducted in parallel as part of a related study but were not included in the present analysis. Patients and/or caregivers were not formally involved in the design of the study or in the analysis of the qualitative data.