Choosing a cancer surgeon: analyzing factors in patient decision making using a best-worst scaling methodology

Ann Surg Oncol. 2014 Nov;21(12):3732-8. doi: 10.1245/s10434-014-3819-y. Epub 2014 Jun 4.


Background: Surgeon experience has been shown to influence outcomes for many types of cancer. The factors that patients consider when selecting a hospital or surgeon for cancer treatment remain poorly defined.

Methods: All patients with a cancer diagnosis seeking treatment at a surgical clinic at Johns Hopkins Hospital were asked to participate. A survey utilizing a best-worst scaling methodology was constructed to elicit the importance of various factors when selecting a cancer surgeon. Attributes were grouped into four categories: surgeon reputation, surgeon qualifications, hospital-related factors, and nonclinical factors.

Results: Two hundred fourteen patients with a cancer diagnosis participated in the study (82.0 % response rate). Patients placed the highest value on physician qualifications and hospital-related factors. Specifically, surgeon case-specific experience (coefficient 2.56, SE 0.06) and the receipt of specialized training by the surgeon (coefficient 2.32, SE 0.06) ranked highest (both P < 0.001). Among hospital-related factors, hospital case-specific volume (coefficient 1.32, SE 0.06; P < 0.001) was most important. The lowest rated factors were parking availability (coefficient -2.81, SE 0.06) and home-to-clinic distance (coefficient -2.12, SE 0.06) (both P < 0.001). The majority of patients reported their ideal surgeon to have at least 6 years of experience (n = 143, 68.1 %) and to have performed their specific procedure at least 50 times (n = 156, 75.3 %).

Conclusions: Patients consider several factors when choosing a cancer surgeon. Surgeon qualifications and hospital-related factors appear to be most influential in their decision. Easier and more widespread dissemination of surgeon and hospital cancer data such as case volume may be useful for patients.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Choice Behavior*
  • Decision Making*
  • Female
  • Humans
  • Male
  • Medical Oncology*
  • Middle Aged
  • Neoplasms / surgery*
  • Outcome Assessment, Health Care
  • Physician-Patient Relations
  • Physicians, Primary Care*
  • Quality Indicators, Health Care*
  • SEER Program