title: Patients' preferences and trade-offs for the treatment of early stage hepatocellular carcinoma.
abstract: BACKGROUND
  Radio frequency ablation (RFA) and hepatic resection (HR) provide similar survival for early stage hepatocellular carcinoma (ES-HCC). Although RFA has a higher recurrence rate, HR is associated with an increased risk of complications and death. When multiple treatments are available, patients should be enabled to direct their preferred therapy. Yet there is lack of knowledge on patients' preferences for the treatment of ES-HCC. The objective of this study was to assess treatment preferences between HR and RFA for ES-HCC.
  
  
  METHODS
  A cohort of 75 cirrhotic adults was educated about the natural history of HCC, treatment options, and the risks and the benefits of HR and RFA. Probability trade-off interviews were used to elicit participants' preferences between the two treatments and strength of their decisions.
  
  
  RESULTS
  RFA was preferred by 70% of participants (P = 0.001) who identified the risk of perioperative morbidity and mortality of HR as the main reasons for their decision. Participants changed their minds if HR could provide better 5 (≥15%) and 3-y disease-free survival (≥10%) when compared with RFA. Their preference also changed when RFA had a median ≥8% risk for complications, ≥5% for mortality, ≥8% for nonradical therapy, and ≥5% for tumor seeding.
  
  
  CONCLUSIONS
  Informed cirrhotic patients prefer RFA for the treatment of ES-HCC. Participants who preferred RFA were more concerned about the risks of perioperative morbidity and mortality of HR than long-term cancer outcomes. Patients' values and attitudes toward risks and benefits for the treatment of ES-HCC should be explicitly elicited and included in multidisciplinary treatment decisions.
authors.affiliation: Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada. Electronic address: mmolinari@hotmail.ca.
authors.forename: Michele
authors.initials: M
authors.lastname: Molinari
authors.affiliation: Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Sarah
authors.initials: S
authors.lastname: De Coutere
authors.affiliation: Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Murray
authors.initials: M
authors.lastname: Krahn
authors.affiliation: Department of Surgery, Virginia Mason Medical Center, Seattle, Washington.
authors.forename: Scott
authors.initials: S
authors.lastname: Helton
authors.affiliation: Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
authors.forename: David R
authors.initials: DR
authors.lastname: Urbach
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000601:surgery*; D017115:Catheter Ablation; D003657:Decision Making; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D057240:Patient Preference / Q000706:statistics & numerical data*; D011446:Prospective Studies; D055815:Young Adult
keywords: Decision aids; Decision analysis; Hepatic resection; Hepatocellular carcinoma; Patients' preferences; Probability trade-off; Radio frequency ablation; Shared decision making; Threshold; Treatment choice