Surrogate Decision-Making by Family Caregivers for Hyperthermic Intraperitoneal Chemotherapy in Gastric Cancer: Qualitative Study in a High-Volume Chinese Center.
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BACKGROUND: Hyperthermic intraperitoneal chemotherapy (HIPEC) has been integrated into the management of gastric cancer (GC) as a combined approach for addressing peritoneal metastasis, serving both prophylactic and therapeutic roles following GC surgery. The pivotal decision regarding HIPEC administration typically arises intraoperatively, creating a complex clinical scenario where family caregivers must act as surrogate decision-makers under substantial time constraints. This decision-making process proves particularly challenging due to limited understanding of the procedure's risk-benefit profile and long-term outcomes among nonmedical surrogates, challenges often exacerbated by the acute stress of the surgical environment. OBJECTIVE: This qualitative study aims to explore how family caregivers of patients with GC navigate the HIPEC decision-making process, specifically examining the facilitators, challenges, and the role of information acquisition that shape the shared decision-making mode. METHODS: This study adopted a qualitative approach using semistructured interviews; 15 family caregivers of patients with GC in a major tertiary hospital in Guangxi Province were selected as research objects through a purposive sampling method. Participants were asked to comment on their experience of surrogate decision-making for the HIPEC process. The Colaizzi 7-step method was used to analyze and summarize the themes. RESULTS: The mean age of the 15 participants was 39.8 (SD 13.29, range 20-68) years, and all patients were on average aged 56.7 (SD 10.78, range 36-74) years. The relationship to the patient was distributed as follows: 33% (5/15) spouses, 60% (9/15) children, and 6% (1/15) other relatives. Four major themes emerged from the data analysis: (1) shared decision-making participation mode (doctor-led passive decision-making and doctor-family shared decision-making); (2) decision-information sources (decision-making information came from medical-care personnel, decision-making information came from the internet, and decision-making information came from acquaintances); (3) challenges in the decision-making process (financial burden and anticipated therapeutic efficacy); and (4) facilitator in the decision-making process (positive health beliefs and cultural dimensions of perceived responsibility: a Confucian perspective). CONCLUSIONS: HIPEC decision-making by family caregivers of patients with GC was primarily passive decision-making, and many obstacles and facilitators were encountered in the process. Medical staff should share information and encourage and guide family caregivers to participate in the decision-making process through decision assistance or decision support.