Abstract
-
Background
Patient values and preferences are important in clinical practice guideline development, but responses indicating reliance on physician judgment may be difficult to interpret. We examined whether such reliance can coexist with explicit preferences about treatment outcomes and trade-offs.
-
Methods
We conducted an exploratory secondary analysis of a 22-item cross-sectional survey completed by 14 adults with anal cancer recruited from four hospitals during guideline development. The survey assessed decision-making participation, responses to specific clinical scenarios, rankings of six treatment goals, and treatment-acceptance thresholds. Ten scenario items included the option “I would follow my treating physician’s judgment.” Analyses were descriptive and emphasized within-participant response patterns.
-
Results
Ten participants (71.4%) generally preferred shared decision-making, yet 11 selected physician judgment in at least one scenario. All 11 completed a full ranking of treatment goals, and 9 completed both trade-off threshold items. Among seven participants who relied on physician judgment for salvage treatment, all completed the ranking and six completed both thresholds; five required at least a 20% survival improvement to accept surgery resulting in a permanent stoma. Although permanent stoma ranked fourth among six goals overall, 11 of 13 respondents required at least a 20% survival improvement to accept such surgery.
-
Conclusions
Reliance on physician judgment did not necessarily indicate an absence of patient preferences. Guideline-related preference studies should distinguish preferences for the decision process, general priorities among outcomes, and context-specific benefit-risk trade-offs. Responses indicating reliance on physician judgment should not automatically be treated as “no preference” or missing information.
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Keywords: Patient Preference; Practice Guideline as Topic; Shared Decision-Making; Patient Participation; Anus Neoplasms; Surveys and Questionnaires
Introduction
Clinical practice guideline recommendations are intended to reflect not only the best available evidence but also the values patients place on the benefits, harms, and other consequences of the available options. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) Evidence to Decision framework therefore treats the values placed on important outcomes, including variability or uncertainty in those values, as a distinct consideration when moving from evidence to recommendations [
1]. Guidance on incorporating patient values and preferences into guideline development similarly emphasizes eliciting the relative importance patients assign to health outcomes [
2].
This concept is related, but not identical to, the role a patient wishes to play in decision-making. Shared decision-making involves information exchange, deliberation, and elicitation of patient preferences, but patients may differ in how much control they want over the final choice [
3,
4]. Preferences for decisional control can also vary across clinical contexts. Scenario-based research has shown that a general preference for an active, shared, or physician-led role does not necessarily predict the role preferred in a specific decision [
5], and studies in cancer care have found that decision characteristics influence whether decisions are patient controlled, shared, or physician controlled [
6]. Patients may also value participation and information while still placing substantial weight on a clinician’s recommendation [
7].
These distinctions create an interpretive problem for guideline developers. When a patient responding to a values-and-preferences survey selects “I would follow my treating physician’s judgment,” the response may be interpreted as indicating no preference, uncertainty, or inability to choose between options. However, the same patient may have clear views about which outcomes matter, harms they wish to avoid, or the magnitude of benefit or risk that would make a treatment acceptable. Treating reliance on physician judgment as equivalent to an absence of values may therefore discard information that is directly relevant to recommendation development.
A second measurement issue is that “outcome preference” itself can be elicited in different ways. Asking patients to rank outcomes in general identifies their relative priorities, whereas asking how much benefit or harm they would accept in a specific clinical choice elicits a contextual trade-off. These forms of preference information may be related but need not be interchangeable. This distinction is especially relevant to guideline development, where judgments about the balance of desirable and undesirable effects depend not only on whether an outcome is important but also on how patients value the magnitude of competing consequences.
Anal cancer provides a useful clinical context in which to examine these issues because management includes decisions with markedly different purposes and trade-offs, including screening in high-risk groups, staging and response assessment, radiation dose and systemic therapy, local excision in selected early-stage disease, and salvage surgery that may result in a permanent stoma [
8-
10]. During the development of an anal cancer clinical practice guideline, we conducted a patient values-and-preferences survey that included a general question about preferred decision-making participation, multiple scenario-specific items, rankings of treatment goals, and treatment-acceptance thresholds. Using these data, the present exploratory analysis examined whether reliance on physician judgment in specific scenarios could coexist with explicit outcome priorities and trade-off preferences, and whether these different forms of preference information should be interpreted separately in guideline development.
Methods
Study design and participants
This study was an exploratory secondary analysis of cross-sectional survey data on patient values and preferences collected during the development of a clinical practice guideline for anal cancer. Eligible participants were adults aged 19 years or older who had been diagnosed with and treated for anal cancer at one of four participating hospitals: Korea University Anam Hospital, Soonchunhyang University Hospital Cheonan, the Catholic University of Korea Uijeongbu St. Mary’s Hospital, and Dongguk University Hospital. The survey was conducted from February 11 to July 27, 2026. Eligible patients who visited the participating hospitals during the survey period were approached in the outpatient setting, and the questionnaire was administered face-to-face by an outpatient-clinic nurse. A total of 14 patients participated. Given the rareness of anal cancer and practical constraints on recruitment, convenience sampling was used. The analysis was designed to describe within-participant response patterns rather than to test a prespecified statistical hypothesis or estimate population proportions with precision.
Survey instrument
The survey consisted of 22 items: four items on demographic and clinical characteristics, two general items on the preferred decision maker and priorities among treatment goals, and 16 items corresponding to key questions in the anal cancer clinical practice guideline. Major clinical scenarios included screening in high-risk populations; additional FDG-PET/CT for staging; timing and use of magnetic resonance imaging for treatment-response assessment; radiation dose in early anal cancer; factors considered when selecting chemotherapy; local excision versus chemoradiotherapy for stage I anal cancer; and salvage treatment for suspected residual cancer.
General decision-making participation was assessed using four response options: “It is best for the physician to make all decisions,” “It is best for the physician and me to discuss and decide together,” “It is best to discuss with my family and follow my family’s opinion,” and “It is best for me to make all decisions.” Participants were also asked to rank six treatment goals from most to least important: cure, symptom relief, quality of life, duration of time during which usual activities could be maintained, treatment-related adverse effects, and whether a permanent stoma would be required. Lower rank values therefore indicated greater importance.
For each clinical scenario item, expected benefits and harms were presented before the patient selected a response. Ten of the 22 items included the option “I would follow my treating physician’s judgment.” For this secondary analysis, selection of this option was operationally coded as reliance on physician judgment. This code was not intended to imply complete transfer of decision-making authority or a desire to avoid participation. Two items separately offered both the physician-judgment option and the option “Both choices have advantages and disadvantages, so it is difficult to decide.” One additional screening-frequency item combined “I do not know” and “I would follow my physician’s judgment” in a single response option. Because uncertainty and reliance on physician judgment could not be distinguished in that item, it was excluded from the primary physician-reliance analysis and examined only in sensitivity analysis.
The survey also assessed two context-specific trade-off thresholds. One item asked the maximum additional local recurrence risk participants would accept when choosing local excision rather than chemoradiotherapy. A second item asked the minimum survival improvement required to accept surgery for suspected residual cancer when the surgery would result in a permanent stoma and involve operative risk.
Classification of clinical scenario items
The 10 items that included an unambiguous physician-judgment option were classified a priori according to clinical content as five diagnostic/evaluation-related items and five treatment-related items. Diagnostic/evaluation-related items addressed screening in high-risk populations, additional FDG-PET/CT for staging, timing of treatment-response assessment, factors considered when determining assessment timing, and magnetic resonance imaging for response assessment. Treatment-related items addressed the treatment goal in early anal cancer, choice between low-dose and standard-dose radiotherapy, factors considered when selecting chemotherapy, treatment choice for stage I anal cancer, and salvage treatment for suspected residual cancer. This classification was specified before response results were reviewed.
Analysis
Categorical results are presented as n/N (%), where N is the number of valid responses to each item. Age is presented as the median and range. Given the sample size and exploratory purpose, the analysis was descriptive; confidence intervals, formal hypothesis tests, regression analyses, and inferential group comparisons were not used.
For each participant, we calculated the number of diagnostic/evaluation-related and treatment-related items in which physician judgment was selected and whether at least one such response occurred in each category. Correspondence between general participation preference and scenario-specific responses was described at the participant level. All participants provided a response to each of the 10 physician-reliance items. One participant marked more than one non-physician-judgment option on three of these single-choice items; because physician judgment itself was not selected in those multiply marked responses, they were classified as not selecting physician judgment in the primary analysis. A sensitivity analysis excluded this participant. Missing responses to the two threshold items were reported separately and were not imputed.
Treatment-goal rankings were summarized using mean and median rank and the numbers of participants placing each goal in the first, top two, or bottom two positions. To assess whether physician reliance represented an absence of elicitable preference information, we described completion of the six-goal ranking and both threshold items among participants who did and did not select physician judgment, including the salvage-treatment scenario. We also descriptively contrasted general outcome rankings with corresponding context-specific choices or thresholds. These comparisons were intended to examine whether the two forms of preference information were non-equivalent and complementary, not to establish psychometric construct validity.
Sensitivity analyses examined the effect of including the screening-frequency item that combined “I do not know” with “I would follow my physician’s judgment,” the influence of the participant with multiple markings, and the distribution of responses across the two threshold items to assess whether clustering in the highest survival-benefit category was compatible with a nonspecific tendency to choose endpoint response categories.
Ethical considerations
The original patient values-and-preferences survey was administered anonymously. Participants were informed in advance that their responses would not affect clinical decisions and would be used as reference information for clinical practice guideline development.
Results
Participant characteristics
Of the 14 participants, 12 (85.7%) were women, and the median age was 59.5 years (range, 40-85 years). Eleven participants (78.6%) reported no risk factor placing them in a high-risk group for anal cancer. All participants had received both radiotherapy and chemotherapy. One participant had undergone both local excision and abdominoperineal resection (
Table 1).
When asked generally who should make decisions about additional tests or treatment options, 10 participants (71.4%) preferred to discuss the decision with their physician and decide together, whereas 4 (28.6%) preferred the physician to make all decisions. No participant preferred to follow the family’s opinion or to make all decisions independently.
Despite the predominance of a general preference for joint decision-making, 11 of 14 participants (78.6%) selected the option to follow the physician’s judgment on at least one of the 10 clinical scenario items. Among the 10 participants who generally preferred to discuss and decide together, 7 selected the physician-judgment option at least once; their median number of such selections was 1.5 (range, 0-6). All 4 participants who generally preferred the physician to make all decisions selected physician judgment in at least one scenario, with a median of 2.5 selections (range, 1-5).
Across the five diagnostic/evaluation-related items, reliance on physician judgment accounted for 7 of 70 item responses (10.0%), ranging from 0 to 2 participants per item. Across the five treatment-related items, it accounted for 20 of 70 item responses (28.6%), ranging from 3 to 7 participants per item (
Table 2). After excluding the salvage-treatment item, 13 of 56 responses (23.2%) across the remaining four treatment-related items indicated reliance on physician judgment. At the participant level, reliance was more frequent for treatment-related than diagnostic/evaluation-related items in 8 participants, equal across the two item types in 4, and more frequent for diagnostic/evaluation-related items in 2. Because the item types also differed in risk, complexity, and clinical consequences, these frequencies were treated as descriptive rather than comparative evidence.
All 14 participants completed a full, nonduplicated ranking of the six treatment goals. This included all 11 participants who selected physician judgment at least once and all 7 who selected physician judgment in the salvage-treatment scenario. Completion of the two trade-off threshold items was also similar across these response patterns: 9 of 11 participants who selected physician judgment at least once and all 3 who never selected it completed both thresholds; among the 7 participants who relied on physician judgment for salvage treatment, 6 completed both thresholds, the same proportion as among the 7 who selected a substantive salvage-treatment option (
Table 3). Thus, selection of physician judgment did not correspond to an absence of elicitable outcome-priority or trade-off information in this sample.
Cure was the highest-ranked treatment goal overall (mean rank, 2.00; median, 1; ranked first by 8 of 14 and in the top two by 10 of 14), followed by quality of life (mean rank, 2.71). Permanent stoma had a mean rank of 3.79, whereas time able to maintain usual activities (4.50) and treatment-related adverse effects (4.57) were ranked lowest on average (
Supplementary Table S1). The three participants who never selected physician judgment all ranked cure first (
Supplementary Table S2. By contrast, all six participants whose first-ranked goal was not cure selected physician judgment at least once; their mean number of physician-judgment selections was 3.00 compared with 1.12 among the eight participants who ranked cure first. Given the small groups, this pattern is considered exploratory.
The clearest within-participant example involved salvage treatment for suspected residual cancer. Seven participants (50.0%) responded that they would follow their treating physician’s judgment when asked to choose among abdominoperineal resection resulting in a permanent stoma, nonsurgical treatment, or observation. Five participants (35.7%) preferred to avoid surgery because of the burden of a permanent stoma, whereas 2 (14.3%) would accept surgery if it offered the possibility of cure.
In the separate survival-threshold item, 13 participants indicated the improvement in survival they would require to accept surgery considering both the permanent stoma and operative risk. Ten selected an improvement of ≥30%, 1 selected 20%-30%, and 2 selected ≤5%. Among the 7 participants who had left the salvage-treatment decision to the physician, 4 selected ≥30%, 1 selected 20%-30%, and 2 selected ≤5% (
Table 4). Thus, 5 of 7 participants who relied on physician judgment for the treatment choice nevertheless indicated that a survival improvement of at least 20% would be required to accept the surgical burden. Across all respondents to the threshold item, 11 of 13 required at least a 20% survival improvement, even though permanent stoma ranked fourth among the six general treatment goals. This illustrates that general outcome rankings and context-specific trade-off thresholds provided complementary rather than interchangeable information.
A similar pattern of contextual preference was observed for stage I anal cancer. Twelve participants answered the additional-recurrence-risk threshold for choosing local excision rather than chemoradiotherapy. Among the 9 participants who selected chemoradiotherapy in the corresponding treatment-choice item, 8 indicated that they would accept no more than a 3% increase in local recurrence risk with local excision (
Supplementary Table S3).
The two items that separately offered both “It is difficult to decide” and the physician-judgment option also suggested that these responses were not interchangeable. For the choice between low-dose and standard-dose radiotherapy, 4 participants selected physician judgment and none selected “It is difficult to decide.” For the timing of treatment-response assessment, one participant selected each response. Because only two items used this response structure, these observations are descriptive only.
Sensitivity analyses and response patterns
The screening-frequency item that combined “I do not know” with “I would follow my physician’s judgment” was excluded from the primary analysis because the two meanings could not be separated. If this combined category were nevertheless counted as physician reliance, the number of participants with at least one physician-reliance response would increase from 11 of 14 (78.6%) to 13 of 14 (92.9%) (
Supplementary Table S4). This item therefore illustrates the measurement consequences of combining uncertainty and reliance on clinician judgment in a single response option.
One participant marked multiple non-physician options on three of the 10 single-choice items used in the physician-reliance analysis. Excluding this participant produced similar descriptive results: 7 of 65 diagnostic/evaluation responses (10.8%) and 19 of 65 treatment responses (29.2%) indicated physician reliance, and 10 of 13 participants (76.9%) selected physician judgment at least once.
The survival-threshold item showed substantial clustering in its highest category: 10 of 13 respondents selected ≥30%. Among the 12 participants who completed both threshold items, however, only one selected the final response category on both items, whereas four selected the first category for acceptable recurrence risk and the final category for required survival improvement (
Supplementary Table S5). This pattern is not consistent with a uniform tendency to choose the same endpoint across questions, although the upper category of ≥30% still created a ceiling that prevented more precise estimation of the required benefit for those respondents.
Participants who more frequently selected physician judgment also tended to select response options indicating no particular expected benefit, burden, or concern on some items; this descriptive pattern was driven largely by the magnetic-resonance-imaging burden item. Such responses could reflect weaker differentiation, lower engagement with some questions, or genuinely neutral perceptions. Importantly, participants with the highest frequencies of physician-judgment responses still completed the treatment-goal ranking and provided distinct outcome-priority profiles, indicating that lower differentiation on some items should not be equated with an absence of outcome values.
Discussion
The principal finding of this exploratory study is that reliance on physician judgment and the absence of patient values and preferences should not be treated as equivalent. Most participants generally preferred joint decision-making, yet many relied on physician judgment in at least one specific scenario. More importantly, participants who selected physician judgment still provided complete rankings of treatment goals and, in most cases, explicit trade-off thresholds. These within-participant patterns show that a response about how a clinical decision should be made does not by itself determine whether a patient has preferences about the outcomes of that decision.
This interpretation is consistent with prior work on decision-making roles. Bradley et al. showed that a general preference for decisional control did not consistently predict preferences across specific clinical scenarios [
5]. Flynn et al. further demonstrated that participation is multidimensional: preferences can differ across information exchange, discussion, and selection of the final treatment [
4]. In cancer care, Keating et al. found that characteristics of the decision itself influenced whether patients reported patient-controlled, shared, or physician-controlled roles [
6]. Tamirisa et al. likewise highlighted that patients may value shared decision-making while still seeking a physician recommendation [
7]. The present study extends these observations in a guideline-development setting by linking scenario-specific reliance on physician judgment with independently elicited outcome priorities and quantitative treatment-acceptance thresholds within the same respondents.
The distinction is particularly important for clinical practice guideline methodology. In the GRADE Evidence to Decision framework, values refer to the importance patients place on the main outcomes of the options under consideration and to variability or uncertainty in those judgments [
1,
2]. A survey response about whether the patient would follow the physician’s judgment therefore does not directly measure how that patient values survival, treatment toxicity, quality of life, recurrence, or a permanent stoma. Coding such a response as “no preference,” undecided, or missing may consequently discard information that is directly relevant to judgments about the balance of desirable and undesirable effects and, ultimately, the direction or strength of a recommendation.
The present data further suggest that guideline-related preference studies should distinguish at least three analytically separable types of information. The first concerns the decision process: the extent to which the patient wishes to participate in deliberation and final choice or to rely on clinician judgment. The second concerns general outcome priorities: which consequences are regarded as more or less important when considered abstractly. The third concerns context-specific trade-offs: the magnitude of benefit or harm that changes whether a concrete option is acceptable. These should not be interpreted as psychometrically validated constructs on the basis of this small study, but they represent different forms of information that may answer different questions in guideline development.
The contrast between general rankings and contextual thresholds was especially informative. Permanent stoma was not among the highest-ranked goals when considered in the abstract, yet most respondents required a large survival improvement before accepting surgery that would result in a permanent stoma. Conversely, the recurrence-risk threshold for local excision was broadly consistent with the treatment choices of participants who preferred chemoradiotherapy. These findings do not imply that threshold questions are inherently superior to rankings. Rather, rankings identify relative priorities across outcomes, whereas thresholds reveal how those priorities operate when benefits and harms must be traded against one another. Both may therefore be useful, but they should not be treated as interchangeable measures of “patient values.”
An exploratory pattern also suggested that preserving physician-reliance responses may be particularly important for patients whose priorities are less dominated by cure. All participants whose first-ranked treatment goal was not cure selected physician judgment at least once, whereas the participants who never selected physician judgment all ranked cure first. The groups were too small for inference, and this observation requires replication. Nevertheless, it raises the possibility that treating physician-reliance responses as missing could disproportionately remove patients whose priorities differ from the most common cure-oriented pattern rather than remove only patients who lack preferences.
Reliance on physician judgment was observed more often in treatment-related than diagnostic/evaluation-related items in this sample. This may reflect the greater perceived consequences, uncertainty, complexity, or responsibility associated with treatment choices, but the present study cannot distinguish among these explanations. The diagnostic and treatment items were not matched for difficulty, information content, risk, response format, or burden. This finding should therefore be regarded as a hypothesis-generating observation about context dependence rather than evidence that patients systematically prefer more physician control for treatment decisions.
The survey also illustrates a practical measurement problem. One item combined “I do not know” and “I would follow my physician’s judgment” into a single response category. Those responses cannot be classified as either uncertainty or reliance without making an assumption, and counting the combined category as physician reliance materially changed the headline proportion of participants with at least one such response. Guideline-related surveys should therefore avoid response options that merge lack of knowledge, decisional difficulty, neutrality, and reliance on clinician judgment, because these responses carry different meanings and may require different follow-up questions.
Strengths and limitations
A strength of this study is its within-participant design: general decision-making preference, responses across multiple real clinical scenarios, general treatment-goal rankings, and context-specific treatment-acceptance thresholds were linked within the same respondents. This allowed the analysis to address conceptual relationships that cannot be inferred from population-level proportions alone. The study also used patients with direct experience of anal cancer treatment recruited across four hospitals, providing an empirical example from a rare disease in which several guideline decisions involve substantial trade-offs.
The study also has important limitations. The sample was very small (n = 14) and recruited by convenience sampling, so the percentages cannot be generalized to the broader population of patients with anal cancer and the stability of the observed patterns is uncertain. The survey was developed for guideline development rather than as a validated instrument for the present analytic question, and response options differed across items. The forced ranking of six treatment goals demonstrates that outcome-priority information could be elicited, but it does not establish that respondents perceived the six goals as clearly or equally distinguishable. The threshold questions used categorical response ranges rather than a validated or iterative preference-elicitation method; in particular, the ≥30% upper category for survival improvement produced a ceiling effect. General participation preference and scenario-specific reliance were not measured on the same scale, and only two items separately distinguished decisional difficulty from physician judgment.
The questionnaire was administered face-to-face by an outpatient-clinic nurse. This mode of administration could have influenced some responses through social desirability or deference to healthcare professionals; however, the study did not assess the degree of prior rapport between respondents and the administering nurse, so the direction and magnitude of any such effect are uncertain. Some participants also gave less differentiated responses on selected items, and one participant marked multiple options on several single-choice questions, although sensitivity analysis excluding that participant did not materially change the principal frequencies.
Most respondents were women, all had received chemoradiotherapy, and only one had experienced a permanent stoma. Preferences based on anticipated outcomes and preferences informed by direct experience were therefore mixed. The survey did not ask why participants chose physician judgment—for example, trust in expertise, decision difficulty, responsibility burden, insufficient information, desire for recommendation, or another reason. Finally, because the analyses were exploratory and descriptive, the observed relationships among decision-process preferences, outcome priorities, and context-specific trade-offs should be treated as hypotheses for future study rather than as validated dimensions of a measurement model.
Future studies should deliberately separate preferences for information sharing, deliberation, and final decisional control from general outcome priorities and context-specific trade-offs. When participants choose to rely on physician judgment, follow-up questions should ask why and should continue to elicit the outcomes that matter and the benefit-risk trade-offs that would make an option acceptable. Preference-elicitation methods that allow more precise estimation beyond categorical ceiling values, combined with qualitative interviews, may be particularly useful. Given the rarity of anal cancer, larger multicenter studies will be needed to determine whether the patterns observed here are reproducible and how these different forms of preference information should be incorporated into guideline Evidence to Decision judgments.
Conclusion
In this exploratory multicenter analysis of patients with anal cancer, reliance on physician judgment in a specific clinical scenario did not necessarily indicate an absence of patient values or preferences. Patients who relied on physician judgment could still identify which outcomes mattered and specify the benefit-risk trade-offs that would make a treatment acceptable. For clinical practice guideline development, preference for the decision process, general outcome priorities, and context-specific trade-offs should therefore be elicited and interpreted as distinct but related forms of information. Responses such as “I would follow my treating physician’s judgment” should not automatically be treated as no preference or missing data; rather, they should prompt further assessment of what outcomes matter and what trade-offs are acceptable.
Notes
Conflict of Interest
Hyun Jung Kim has been an editor of the Journal of Evidence-Based Practice since 2025. However, she was not involved in the peer reviewer selection, evaluation, or decision process of this article. No other potential conflicts of interest relevant to this article were reported.
Funding
The authors received no specific funding for this work.
Data Availability Statement
The datasets generated and/or analyzed in the current study are available from the corresponding author on reasonable request.
Ethics Approval and Consent to Participate
Not applicable.
Authors' Contributions
Conceptualization: HJK, HSR, JMK. Data curation: HSR, JMK, KYL, DHK. Formal analysis: HJK, HSR, DHK, DK. Methodology: HJK, HS. Project administration: HSR, HS, JK. Visualization: JMK, DHK, HJK. Writing – original draft: HS, HJK, HSR, KYL. Writing – review & editing: HJK, JMK, DK, HS, HSR, KYL.
Supplementary Materials
Table 1.Participant Characteristics (N = 14)
|
Characteristic |
n |
% |
|
Sex: Female |
12 |
85.7 |
|
Sex: Male |
2 |
14.3 |
|
Age, median (range), years |
59.5 (40-85) |
- |
|
High-risk factor: None |
11 |
78.6 |
|
High-risk factor: History of intraepithelial neoplasia or cancer |
2 |
14.3 |
|
High-risk factor: HIV infection |
1 |
7.1 |
|
Treatment experience: Radiotherapy |
14 |
100.0 |
|
Treatment experience: Chemotherapy |
14 |
100.0 |
|
Treatment experience: Local excision |
1 |
7.1 |
|
Treatment experience: Abdominoperineal resection |
1 |
7.1 |
Table 2.Responses Indicating Reliance on Physician Judgment by Clinical Scenario (N = 14 for each item)
|
Clinical scenario item |
n |
% |
|
Diagnostic/evaluation-related items
|
|
|
|
Factors important when determining timing of treatment-response assessment |
0 |
0.0 |
|
Timing of treatment-response assessment |
1 |
7.1 |
|
Screening in high-risk populations |
2 |
14.3 |
|
Additional FDG-PET/CT for staging |
2 |
14.3 |
|
Magnetic resonance imaging for response assessment |
2 |
14.3 |
|
Treatment-related items
|
|
|
|
Treatment goal in early anal cancer |
3 |
21.4 |
|
Factors important when selecting chemotherapy |
3 |
21.4 |
|
Treatment choice for stage I anal cancer |
3 |
21.4 |
|
Low-dose vs standard-dose radiotherapy |
4 |
28.6 |
|
Salvage treatment for suspected residual cancer |
7 |
50.0 |
Table 3.Completeness of Outcome-Preference Information According to Reliance on Physician Judgment
|
Response pattern |
n |
Complete six-goal ranking |
Both threshold items completed |
|
Physician judgment selected for salvage treatment |
7 |
7/7 (100%) |
6/7 (85.7%) |
|
Substantive option selected for salvage treatment |
7 |
7/7 (100%) |
6/7 (85.7%) |
|
Physician judgment selected at least once across 10 items |
11 |
11/11 (100%) |
9/11 (81.8%) |
|
Physician judgment never selected across 10 items |
3 |
3/3 (100%) |
3/3 (100%) |
Table 4.Salvage-Treatment Choice and Survival-Improvement Threshold for Accepting Surgery (N = 14)
|
Response to salvage-treatment item |
n |
≤5% |
5-10% |
11-20% |
20-30% |
≥30% |
Missing |
|
Surgery if cure could be expected |
2 |
0 |
0 |
0 |
0 |
2 |
0 |
|
Avoid surgery because of burden of permanent stoma |
5 |
0 |
0 |
0 |
0 |
4 |
1 |
|
Follow treating physician’s judgment |
7 |
2 |
0 |
0 |
1 |
4 |
0 |
|
Total |
14 |
2 |
0 |
0 |
1 |
10 |
1 |
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