• Alisa N Blumenthaler, Kristen Ashlee Robinson, Caitlin Hodge, Lianchun Xiao, Elizabeth J Lilley, James F Griffin, Michael G White, Ryan Day, Kimberson Tanco, Eduardo Bruera, and Brian D Badgwell.
• Departments of Surgical Oncology; University of Texas MD Anderson Cancer Center, Houston, TX.
• Ann. Surg. 2023 Nov 1; 278 (5): e1110e1117e1110-e1117.

ObjectiveTo evaluate whether patients with advanced cancer prefer surgeons to use the best case/worst case (BC/WC) communication framework over the traditional risk/benefit (R/B) framework in the context of palliative surgical scenarios.BackgroundIdentifying the patient's preferred communication frameworks may improve satisfaction and outcome measures during difficult clinical decision-making.MethodsIn a video-vignette-based randomized, double-blinded study from November 2020 to May 2021, patients with advanced cancer viewed 2 videos depicting a physician-patient encounter in a palliative surgical scenario, in which the surgeon uses either the BC/WC or the R/B framework to discuss treatment options. The primary outcome was the patients' preferred video surgeon.ResultsOne hundred fifty-five patients were approached to participate; 66 were randomized and 58 completed the study (mean age 55.8 ± 13.8 years, 60.3% males). 22 patients (37.9%, 95% CI: 25.4%-50.4%) preferred the surgeon using the BC/WC framework, 21 (36.2%, 95% CI: 23.8%-48.6%) preferred the surgeon using the R/B framework, and 15 (25.9%, 95% CI: 14.6%-37.2%) indicated no preference. High trust in the medical profession was inversely associated with a preference for the surgeon using BC/WC framework (odds ratio: 0.83, 95% CI: 0.70-0.98, P = 0.03). The BC/WC framework rated higher for perceived surgeon's listening (4.6 ± 0.7 vs 4.3±0.9, P = 0.03) and confidence in the surgeon's trustworthiness (4.3 ± 0.8 vs 4.0 ± 0.9, P = 0.04).ConclusionsSurgeon use of the BC/WC communication framework was not universally preferred but was as acceptable to patients as the traditional R/B framework and rated higher in certain aspects of communication. A preference for a surgeon using BC/WC was associated with lower trust in the medical profession. Surgeons should consider the BC/WC framework to individualize their approach to challenging clinical discussions.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

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