Surgical decision-making in advanced-stage non–small cell lung cancer is influenced by more than just guidelines

• DOI: 10.1016/j.xjon.2022.04.035
• Publication Date: 2022-04-28T02:12:25Z
• Authors: Terrance Peng; Albert J. Farias; Kimberly A. Shema...; Anthony W. Kim; Sean C. Wightman; Scott M. Atay; Robert J. Canter; Elizabeth A. David
• Keywords: Clinical Sciences; Oncology and Carcinogenesis; Thoracic: Lung Cancer; NSCLC; 7.3 Management and decision making; 03 medical and health sciences; non–small cell lung cancer; 0302 clinical medicine; 7.1 Individual care needs; Clinical Research; Health Services and Systems; Health Sciences; Lung; Cancer; disparities; Biomedical and Clinical Sciences; Lung Cancer; Evaluation of treatments and therapeutic interventions; 16. Peace & justice; 3. Good health; ThORN; surgical decision-making; qualitative; Thoracic Surgery Outcomes Research Network; Patient Safety; Management of diseases and conditions; 6.4 Surgery; multidisciplinary

This qualitative study sought to uncover factors that influence decisions offer curative-intent surgery for patients with advanced-stage (stage IIIB/IV) non-small cell lung cancer.A trained interviewer conducted open-ended, semistructured telephone interviews cardiothoracic surgeons in the United States. Participants were recruited from Thoracic Surgery Outcomes Research Network, subsequent diversification through snowball sampling. Four hypothetical clinical scenarios presented, each demonstrating varying levels of ambiguity respect international guideline recommendations. Interviews continued until thematic saturation was reached. Interview transcripts coded using inductive reasoning and conventional content analysis.Of 27 participants, most had been practice ≤20 years (n = 23) academic 18). When considering nonguideline-concordant surgeries, participants aware relevant guidelines but acknowledged their limitations unique scenarios. Surgeons perceived a common barrier offering is incomplete nonsurgeon physician understanding surgical capabilities or expected morbidity; improved education necessary correct these misperceptions. expressed concern undertaking controversial resection an individual patient could fracture trust built long-term professional relationships. may face pressure operate despite low expectation benefit, leading emotional turmoil surgeon.This generates hypothesis scope current guidelines, availability trial protocols, knowledge among colleagues, interprofessional relationships, all surgeon's willingness cancer.