Values elicitation among surgical oncologists: Findings from an international survey

Abstract

Background: Values elicitation, the structured process of clarifying what matters most to patients, is essential to patient-centered care in surgical oncology. This study examined how surgeons elicit, document, and incorporate patient values into surgical decision-making in clinical practice.

Methods: We conducted a 26-question international online survey (May-June 2025) assessing self-reported values elicitation practices among surgical oncologists, focusing on timing, methods, documentation, communication, and preparedness. The survey was distributed through professional networks using convenience and snowball sampling methods, wherein participants were recruited directly or referred by peers. Descriptive statistics summarized responses, and free-text answers were thematically analyzed.

Results: Ninety-one surgical oncologists responded to the survey. Most were male (n = 40, 56 %) and White (n = 52, 74 %), specializing in gastrointestinal (n = 32, 44 %), breast (n = 24, 33 %), or skin/soft tissue (n = 24, 33 %) oncology. Most reported eliciting patient values (n = 69, 87 %) and initiating values conversations (n = 52, 73 %). Surgeons reported documenting values (n = 55, 77 %) in the electronic health record and communicating them during tumor boards (n = 50, 83 %). Most surgeons (n = 48, 67 %) reported that patient values influenced recommendations in fewer than 25 % of cases. Nearly all (n = 69, 97 %) reported navigating treatment recommendations that conflicted with patients' values. Narrative responses identified three strategies: direct questioning, goals-of-care framing, and shared decision-making dialogue. Time constraints (n = 50, 70 %) and limited training (n = 19, 27 %) were key barriers. Most (n = 66, 93 %) felt prepared, yet 78 % (n = 56) desired additional training.

Conclusions: While values elicitation was widely reported by surgical oncologists, it often did not influence surgical recommendations. Findings highlight the need to re-evaluate approaches and training for integrating patient values in surgical decision-making.

Keywords: Clinical decision-making; Goals; Patient-centered care; Social values.