Patient experiences in trials of minimally invasive thoracic surgery: A mixed-methods study

Patient experiences in trials of minimally invasive thoracic surgery: A mixed-methods study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Patient experiences in trials of minimally invasive thoracic surgery: A mixed-methods study Jennifer Donnelly, Adam Brook, Gavin Wright This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8824381/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 01 Apr, 2026 Read the published version in Journal of Robotic Surgery → Version 1 posted 10 You are reading this latest preprint version Abstract Background Minimally invasive thoracic surgery, including robotic-assisted and video-assisted approaches, is increasingly used to treat lung cancer. While technical outcomes are well documented, patient experiences within clinical trials remain under-explored. Objective To evaluate patient experiences of clinical trial participation involving advanced surgical modalities for lung cancer. Methods This dual-center, mixed-methods study evaluated patient perceptions of participation in the DURATION (ctDNA monitoring) and VGT-309 (fluorescent imaging) trials. Twenty-six participants completed quantitative surveys assessing pre-trial expectations, experiences, and collaboration with research teams. Sixteen participants completed semi-structured interviews, analyzed using thematic analysis. Results Twenty-six participants completed surveys and sixteen completed interviews. Motivations for enrollment included advancing science (100%), altruism (80.8%), and personal benefit (61.5%). Satisfaction was universally high, with participants reporting positive surgical experiences, supportive staff interactions, and minimal procedural burden. Most participants (88.5%) expressed willingness to participate in future trials, and 96.2% would recommend trial involvement to others. Qualitative analysis identified seven domains characterizing patient experiences throughout the trial process: motivations for enrollment, communication from the trials team, influences on surgical decision-making, surgical expectations, postoperative care, challenges to participation, and overall experience. Challenges such as perioperative anxiety and logistical demands were minor and did not detract from overall satisfaction. Overall, participants described the trial experience as seamless and personally meaningful. Conclusion Patients undergoing robotic-assisted or video-assisted thoracic surgery within clinical trials report overwhelmingly positive experiences. The integration of patient-centered communication and advanced technology creates a seamless perioperative journey. Clinicians should not hesitate to enroll appropriate patients in trials featuring surgical innovations. robotic-assisted surgery video-assisted thoracic surgery (VATS) lung cancer surgery patient-reported outcomes clinical trials surgical innovation INTRODUCTION Lung cancer remains the leading cause of cancer-related mortality worldwide [ 1 , 2 ]. The surgical management of pulmonary malignancies has undergone a significant paradigm shift since the introduction of the da Vinci surgical system (Intuitive Surgical, Sunnyvale, CA), with robotic-assisted thoracic surgery and video-assisted thoracic surgery emerging as standard minimally invasive approaches [ 3 ]. Robotic platforms offer technical advantages including tremor elimination, increased degrees of freedom, superior surgeon ergonomics, and enhanced three-dimensional visualization [ 4 ]. These advantages translate to clinical benefits: large-scale database analyses and systematic reviews have demonstrated that robotic-assisted lobectomy is associated with lower perioperative morbidity, reduced 30-day mortality, and fewer early postoperative complications compared to open thoracotomy, with comparable long-term survival [ 5 , 6 ]. The present study drew participants from two clinical trials investigating advanced monitoring and imaging technologies: The DURATION Trial : This protocol uses droplet digital PCR to track circulating tumor DNA (ctDNA) in patients’ blood, enabling detection of molecular signs of cancer recurrence after minimally invasive lung cancer resection. The VGT-309 Trials : These protocols evaluate abenacianine, an imaging agent that, when injected before surgery, causes tumor cells to fluoresce under near-infrared light, aiding localization and more precise identification of cancer margins. While the safety and feasibility of robotic platforms and established imaging adjuncts are well-documented [ 7 ], patient experiences within complex trial frameworks remain under-explored. Prior studies of patient experiences in experimental oncology trials suggest that decision-making is often influenced by a strong desire for personal benefit, leading patients to emphasize potential gains over risks; many participants also express a need for clearer, simplified information to better understand the trial’s primary scientific purpose versus its clinical limitations [ 8 ]. Research into patient perceptions of surgical innovation remains remarkably sparse. While many patients associate robotic-assisted platforms with advanced precision and faster recovery, these views are often shaped more by marketing language than by clinical evidence [ 9 ]. Prior research also indicates that patients may harbor anxieties about robotic surgery, including concerns about equipment reliability and reduced surgeon involvement [ 9 – 11 ]. Understanding how these perceptions influence trial participation remains important for optimizing recruitment. This study aims to evaluate patient experiences of robotic-assisted and video-assisted thoracic surgery within clinical trial settings. The question addressed here - which remains unaddressed in the medical literature - is how patients perceive being on a clinical trial when they have a life-threatening illness and are being treated with advanced surgical modalities. The answer will be of interest to physicians deciding whether to refer patients to clinical trials, and to those wishing to conduct trials involving life-threatening illnesses and advanced surgical techniques. METHODS Study Design and Ethical Oversight This mixed-methods study combined quantitative survey data with qualitative insights from semi-structured interviews to develop a nuanced understanding of the patient experience. The study protocol received institutional review board approval from the St. Vincent’s Hospital Melbourne Research Ethics Committee (Approval No. 086/25). The research team included academics, thoracic surgeons, and clinical trial coordinators with expertise in qualitative and quantitative methods. Setting and Participant Selection The recruitment base comprised patients enrolled in the DURATION (ddPCR; HREC 168.18) and VERGENT (VGT-309; HREC 051.21 and VGT-309 2B; HREC 076.24) trials who underwent either robotic-assisted or video-assisted thoracic surgery (VATS) at St. Vincent’s Hospital Melbourne or St. Vincent’s Private Hospital Melbourne. To be eligible, participants were required to be 18 years of age or older and proficient in English. Vulnerable populations, including Aboriginal and Torres Strait Islander Peoples, were excluded from this specific sub-study. Recruitment and Consent Eligible participants were initially contacted via telephone to gauge interest, followed by an email containing a link to a digital survey with an embedded information and consent form. For the qualitative component, purposive sampling was employed to ensure a diverse representation of age, sociodemographic status, and gender to reduce confounding factors. These participants were invited via telephone for a semi-structured interview, with formal consent materials provided electronically or via post. Interviews were scheduled at the participant’s convenience and conducted face-to-face, via telephone, or through videoconferencing. Data Collection Quantitative Survey : An estimated 10–15 minute patient experience survey was developed in REDCap, informed by established frameworks for assessing the research participant experience [ 12 ]. The instrument explored patient perspectives across three domains: (1) pre-trial expectations, (2) peri-trial experiences, and (3) perceived collaboration with the research and healthcare teams (Supplement 1). Qualitative Interviews One-on-one semi-structured interviews (approximately 15–20 minutes) were audio-recorded. An interview guide with open-ended questions was developed to explore participant experiences in depth (Supplement 2). Participants were given the opportunity to review their responses prior to analysis; no changes were requested. Data Analysis Quantitative Analysis Survey data were exported from REDCap and analyzed using descriptive statistics in SPSS Statistics version 31.0.1 [ 13 ]. Qualitative Analysis Audio recordings were transcribed verbatim and analyzed using thematic analysis [ 14 ]. Two researchers (JD and AB) independently coded the data in ATLAS.ti Web [ 15 ]. Themes and subthemes were developed through discussion until consensus was reached. This independent process was maintained until a final consensus was reached on the thematic framework, ensuring methodological rigor and inter-rater reliability. This mixed method study was reported in accordance with the Good Reporting of a Mixed Method Study (GRAMMS) checklist [ 16 ]. RESULTS Participant Characteristics A total of 26 participants completed the quantitative survey. The cohort was nearly evenly distributed by gender (53.8% women, 46.2% men) and primarily represented an older demographic, with 65.4% of participants aged 65 years or older. Most participants were retired (n = 17, 65.4%), while 8 (30.8%) remained in the workforce. The majority of the cohort (61.5%) had no prior experience with clinical trial participation. Of the 25 participants invited for a semi-structured interview, 16 consented and completed the session (64.0% response rate). The interview sub-cohort mirrored the broader survey population regarding gender (50.0% women) and age (62.5% aged > 65 years). Detailed participant demographics are provided in Table 1 . Table 1 Characteristics of participants who completed a semi-structured interview (n = 16) or survey (n = 26) Category Semi-structured interviews n (%) Survey n (%) Gender Women 8 (50.0) 14 (53.8) Men 8 (50.0) 12 (46.2) Age (years) 35–54 3 (18.8) 3 (11.5) 55–64 3 (18.8) 6 (23.1) 65–74 6 (37.5) 10 (38.5) 75+ 4 (25.0) 7 (26.9) Employment Type Employed/Self-Employed 5 (31.3) 8 (30.8) Retired 10 (62.5) 17 (65.4) Other/Unemployed 1 (6.2) 1 (3.8) Quantitative Survey Results Survey results are organized into three key areas: enrollment motivations, satisfaction and clinical outcomes, and future participation intentions. Trial Enrollment and Motivations Participants reported high levels of satisfaction with the pre-trial enrollment process; 100% agreed they received all necessary information and felt comfortable asking questions prior to consent. Primary motivations for enrollment (respondents could select multiple) included: Scientific Advancement: 100% aimed to help advance science for lung cancer treatment. Altruism: 80.8% sought to help future patients suffering from lung cancer. Personal Benefit: 61.5% hoped to obtain superior treatment for their own condition. Satisfaction and Clinical Outcomes Overall satisfaction with the clinical trial was 100%. Specific high-satisfaction metrics included the surgical experience (100%), care provided by hospital-based trial staff (96.2%), and information regarding post-trial support (84.7%). Participants perceived the trial as both beneficial and low burden. 96.1% felt they had contributed meaningfully to medical research, and 84.6% reported an improved quality of life. Furthermore, 84.7% of participants disagreed that the trial was time-consuming or interfered with their daily routines. Future Participation and Recommendations Engagement levels remained high regarding future research; 88.5% of respondents indicated a willingness to participate in a future randomized clinical trial (RCT) should there be no clear “gold standard” treatment. Additionally, 96.2% stated they would recommend participation in this specific study or future trials conducted by this research team. Qualitative Interview Results Thematic analysis of the semi-structured interviews yielded fifteen themes and seven sub-themes organized across seven core domains. These findings provide a deeper understanding of the survey data, detailing the nuanced experiences and perceptions of the participants. A summary of these domains, themes, and sub-themes, accompanied by illustrative participant quotes, is presented in Table 2 . Detailed findings for each domain are presented below. Table 2 Qualitative Domains, Themes, and Representative Quotes Regarding Patient Experiences in Minimally Invasive Thoracic Surgery Clinical Trials. Theme Subtheme Representative Quote Domain 1: Motivations and Influences Regarding Enrollment Altruistic Motivations Desire to contribute to medical knowledge “You feel good. You’re helping other people.” (ID06) Expectation of Superior Care Perceived advantage of specialized oversight “The doctor comes, or the trial people come, and you sort of felt at ease because … you had a lot of people looking after you.” (ID03) Risk-Benefit Appraisal Personal health goals vs. trial objectives “I was very comfortable going along with it. It was just hopefully a tool that would aid the surgeon and I was all for that.” (ID10) Foundational Trust Confidence in study protocol and surgical expertise “If somebody talks to me about a trial and it seems to me that it makes sense, then I'll definitely do it.” (ID01) Domain 2: Communication from the Clinical Trials Team Protocol and Consent Clarity Transparency of study procedures “They sort of explained everything really well.” (ID03) Staff Attentiveness and Empathy Reassurance through clinical team rapport “I just remember the clinical trial staff as being very thorough and pleasant … they were certainly reassuring.” (ID04) Domain 3: Influences on the Decision to Undergo Surgery Surgeon-Related Influences Trust in the surgeon’s expertise “I felt 100% confident with [surgeon’s name].” (ID07) Referring doctors’ endorsement of the surgeon “[Surgeon’s name] was referred to me by my own personal doctor out here who knew him.” (ID07) Surgeon’s communication style and explanations boosted confidence “The trial was explained to me very clearly … I was very comfortable going along with it.” (ID10) Perceptions of Surgical Modality and Outcomes Perceived procedural advantages (e.g., precision, rapid recovery) “[It’s] very precise, so I was sort of with ease after that.” (ID03) “It would be a lot more steady for the surgeon. There’s no shaking, there’s no ifs and buts, it’s very clean in and out.” (ID06) Domain 4: Expectations of Surgery within the Clinical Trial Congruence of Surgical Expectations and Clinical Outcomes Perceived clinical benefits of surgical resection “It wasn't just the central lobe, which was the prediction, but it was something in the lower lobe … They discovered extra areas they needed to take out.” (ID14) Positive recovery trajectory and minimal procedural burden “Normally after these robotic surgeries, they’re all fine. I recover very quickly.” (ID01) “Because it’s less invasive … you’re not sliced open so much.” (ID02) “You’re going and get a lung operation to get cancer removed overnight and come home. There’s not much to complain about … It’s a bit of a no-brainer.” (ID06) Domain 5: Postoperative Care and Follow-up Continuity of Support Accessibility of trial-specific support staff “I had numbers to ring, but I didn’t need to talk to anyone to tell you the truth.” (ID07) “Really positive. I felt like I was in really good hands. I had strong communication. [The clinical trials nurse] gave me her mobile number and got in contact, you know, frequently post that meeting as well as to next steps.” (ID11) Adequacy of Follow-up Protocols Perceived adequacy of postoperative monitoring “Afterwards … blood tests and the ECGs and then … a couple of phone calls after. So, it wasn’t very, it wasn’t very involved.” (ID02) Domain 6: Challenges to Clinical Trial Participation Perioperative Anxiety Management Normalization of perioperative apprehension “I would understand nervousness ... it wasn't long before I was back to normal again.” (ID16) Logistical and Time Commitments Minimal impact of trial-related time commitments “I understand it’s to help other people as well as myself. I was treated really well … I went back quite a few times with blood tests done and testing the heart … and [it] wasn’t really any interruption in my time.” (ID06) Domain 7: Overall Experience Perceived Continuity and “Seamlessness” Perceived ease of the surgical journey “It was very seamless.” (ID10) “It was a really easy, positive experience.” (ID13) “I can't believe I had some of my lung taken out, and I can't tell ... You can hardly see the scars. The little things. It’s just unbelievable.” (ID07) Propensity for Future Participation and Advocacy Willingness to advocate for clinical research “I would say give it, give it a go... my experience... it wasn't long before I was back to normal again.” (ID16) “If you can get more advanced medical care, definitely.” (ID06) Note : ID, participant identification number; ECG, electrocardiogram. Brackets [ ] indicate text added or modified for clarity or de-identification. Ellipses (...) indicate omitted text for brevity. DOMAIN 1: MOTIVATIONS AND INFLUENCES REGARDING ENROLLMENT Participants were motivated to enroll by a convergence of altruistic intent and personal benefit, viewing trial participation as both a contribution to medical progress and an opportunity to access specialized care. These motivations were reinforced by foundational trust in the research protocol, surgical team, and institution. A prominent driver was the desire to advance medical science and help future patients. Participants viewed their involvement as personally meaningful even while facing a life-threatening diagnosis, with one noting: “I just thought it was important to me personally... to get the cancer removed for a start, but... to understand that I’m helping in some small way, helping advance a bit of science.” (ID12). Beyond altruism, participants anticipated that trial enrollment would provide access to enhanced medical attention, describing it as an opportunity to receive “the most advanced thing at the moment, which means I'm getting the best of care” (ID06). The perception of low risk and high potential benefit made enrollment appear both logical and appealing. Foundational trust was critical. Endorsements from referring physicians played a significant role, as did the surgeon's communication style. Trust extended to the institution itself, with participants expressing confidence that any trial conducted within the hospital would be managed with appropriate clinical rigor. DOMAIN 2: COMMUNICATION FROM THE CLINICAL TRIALS TEAM Participants consistently described interactions with clinical trial staff as clear, thorough, and supportive. Information regarding the study protocol and consent process was communicated transparently, with participants receiving detailed written materials and being encouraged to consult with family members and personal physicians before providing consent. Interactions with staff were characterized by professionalism, empathy, and attentiveness. Even those with minimal contact found reassurance in knowing support was readily accessible. Overall, participants described their engagement with the clinical trials team as aligning with expectations for pleasant, supportive, and professional care. DOMAIN 3: INFLUENCES ON THE DECISION TO UNDERGO SURGERY The decision to undergo minimally invasive surgery was shaped by three factors: trust in the surgeon’s expertise, endorsements from referring physicians, and favorable perceptions of the surgical modality. Trust in the surgeon was central. Participants emphasized the importance of the surgeon’s specialized skills, with professional endorsement from referring doctors providing critical reassurance. One participant explained: “[Surgeon's name] was referred to me by my own personal doctor out here who knew him, and I just did not have any concerns at all about what he was going to do with robotics” (ID07). Robotic-assisted and video-assisted surgery were widely viewed as offering superior precision and outcomes compared to open surgery. Participants anticipated faster recovery and minimal physical burden, with one characterizing it as “a bit of a no-brainer” (ID06). These perceptions were reinforced by independent research, testimonials, and confidence in Australia’s healthcare safety standards. DOMAIN 4: EXPECTATIONS OF SURGERY WITHIN THE CLINICAL TRIAL Participants’ expectations were largely met or exceeded, with many reporting outcomes that surpassed initial anticipations. Recovery was characterized by short hospital stays, minimal pain, and rapid return to normal activities. One participant reflected: “I can’t believe I had some of my lung taken out, and I can’t tell... you can hardly see the scars... It’s just unbelievable” (ID07). Participants identified specific clinical benefits from trial participation, particularly regarding tumor detection. Several reported that more lesions were identified and resected than anticipated based on preoperative imaging: “It lights up the tumour and there’s this nice big bright green spot and he said we got that and by the way we’ve got two others as well that they found” (ID01). Overall, the trial framework was seen as enhancing rather than complicating the surgical experience. DOMAIN 5: POSTOPERATIVE CARE AND FOLLOW-UP Postoperative care was described as straightforward and supportive. Having direct access to clinical trial staff provided significant reassurance, regardless of whether participants actively utilized this support. The variability in follow-up intensity reflected individual needs, with participants expressing satisfaction that support was appropriately tailored to their recovery trajectories. Follow-up comprised standard surgical procedures including reviews with the surgeon and calls from trial coordinators. This low burden was viewed positively, as trial-related requirements did not impose significant demands beyond standard postoperative care. Minor complications were perceived as resolving over time and within expectations previously outlined by the surgical team. DOMAIN 6: CHALLENGES TO CLINICAL TRIAL PARTICIPATION Challenges were characterized as minor inconveniences rather than significant barriers. Perioperative anxiety was acknowledged but viewed as a standard aspect of undergoing surgery rather than trial-specific. Confidence in the surgical team and the minimally invasive approach mitigated much of this anxiety. Logistical demands posed only minor hurdles. One participant described the pre-surgical day as “tedious” but “not difficult” (ID01). Time commitments were generally perceived as manageable and justified by anticipated benefits. Hospital parking was mentioned by some as a minor inconvenience but not a substantial barrier. DOMAIN 7: OVERALL EXPERIENCE Participants reported an overwhelmingly positive experience, frequently characterizing the process as straightforward, seamless, and personally meaningful. The integration of trial procedures into standard surgical care was found unobtrusive and well-coordinated. All participants indicated willingness to enroll in future clinical trials, provided the protocol is appropriate and scientifically sound. Responses regarding recommending trial participation were uniformly positive, though participants emphasized the importance of critically evaluating information before consenting. Altruism emerged as a sustained motivator throughout, with participants expressing satisfaction that their involvement could benefit future patients. DISCUSSION This mixed-methods study explored the experiences of participants enrolled in clinical trials involving robotic-assisted surgery or VATS across two tertiary centers in Melbourne, Australia. To our knowledge, this is the first study to examine patient satisfaction when advanced surgical modalities are combined with clinical research protocols. The findings demonstrate that patients are highly satisfied with trial participation because the experience directly aligns with their primary motivations for enrolling: advancing science, altruism, and personal benefit. Participant satisfaction was underpinned by three factors: First, the desire for better treatment was met by deep trust in the surgeon’s expertise and the perceived precision of fluorescence-guided surgery. The use of fluorescent imaging acted as a “technological GPS,” reassuring patients that their tumors were being identified and resected with more accuracy than the naked eye. Structured pre-operative education and transparent communication were pivotal in fostering this confidence, aligning with previous research highlighting the positive impact of clear information on patient perceptions in robotic-assisted surgery [ 9 ], other surgical contexts [ 17 , 18 ], and clinical trials broadly [ 19 – 21 ]. Second, participants appreciated the rigorous surveillance inherent to trial protocols. In the DURATION study , knowing their progress was being monitored more frequently than in standard care provided a sense of security. This perception that trial participation offers superior care is consistent with prior research [ 20 , 22 , 23 ]. Third, the altruistic goal of helping others—consistent with prior research on trial motivations [ 23 ]—was supported by an experience participants frequently characterized as “ seamless ”. Minimal surgical discomfort and faster recovery through minimally invasive approaches allowed participants to contribute to medical progress without undue physical burden. These results suggest that physicians should not hesitate to enroll patients in appropriate trials featuring novel technology. The perceived risk of the “unknown” is outweighed by patients’ desire to advance science and the reassurance provided by an empathetic clinical trials team. Future studies should examine whether these findings generalise to other surgical specialties, diverse patient populations, and different types of technological innovation. Strengths and Limitations A primary strength of this study is the mixed-methods design, which combined quantitative survey data with qualitative interviews to yield a nuanced understanding of patient experiences. The qualitative component provided deep insight into motivations, trust, communication, and perceptions of surgical innovation. This study has several limitations. First, the self-reported nature of both surveys and interviews may introduce social desirability bias, with participants potentially overstating satisfaction. Second, the cohort was drawn from a single geographic region (Melbourne) and comprised predominantly older, retired individuals, which may limit generalisability to younger or working populations. Third, only participants who completed the trial were included, potentially excluding those with negative experiences who withdrew. Fourth, the focus on lung cancer resections within specific trial protocols may not reflect experiences in other surgical specialties or trial designs. CONCLUSION This study demonstrates that participants undergoing robotic-assisted surgery or VATS within a clinical trial framework report overwhelmingly positive experiences, often describing the perioperative journey as “ seamless ”. This high level of satisfaction is driven by a desire to advance scientific knowledge and a perception that trial participation offers superior clinical precision and rigorous monitoring. The findings provide strong support for enrolling patients in appropriate clinical trials involving advanced surgical technology. Participants viewed technical innovation and trial-specific surveillance not as burdens, but as significant sources of reassurance and personal benefit. By integrating patient-centered communication with advanced surgical platforms, clinical trials can provide an experience that meets, and often exceeds, the expectations of patients navigating a life-threatening diagnosis. Declarations Funding Source: The authors declare that no funds, grants, or other support were received during the preparation of this manuscript. Ethics Approval: This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by St. Vincent’s Hospital Human Research Ethics Committee (Approval No. 086/25). Author Contributions : J.D., A.B. and G.W. contributed to the design. J.D. completed data collection. J.D. and A.B. completed formal analysis. All authors participated in writing, reviewing and editing of the manuscript. Conflict of interest statement: No conflict of interests to be declared. References Siegel RL, Miller KD, Wagle NS, Jemal A (2023) Cancer statistics. 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Supplementary Files Supplement1SurveyClinicalTrialsExperiences.pdf Supplement2Semistructuredinterviewguide.docx GRAMMSMixedmethodClinicaltrialsexperiences.docx Cite Share Download PDF Status: Published Journal Publication published 01 Apr, 2026 Read the published version in Journal of Robotic Surgery → Version 1 posted Editorial decision: Revision requested 25 Feb, 2026 Reviews received at journal 25 Feb, 2026 Reviewers agreed at journal 18 Feb, 2026 Reviews received at journal 18 Feb, 2026 Reviewers agreed at journal 18 Feb, 2026 Reviewers agreed at journal 16 Feb, 2026 Reviewers invited by journal 16 Feb, 2026 Editor assigned by journal 11 Feb, 2026 Submission checks completed at journal 11 Feb, 2026 First submitted to journal 08 Feb, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8824381","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":593423407,"identity":"dd7382a4-8f66-4eaf-a85b-84f5fbe76af2","order_by":0,"name":"Jennifer Donnelly","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA7klEQVRIiWNgGAWjYBACxgYGAxAtw8fAfIABwk4goKUNooyHjYEtgTgtDGxwLTwGUCECWpjnN298XLjDhodNIufzZ56COwz87DkGDD/b8DmMrdh45pk0oJbcbdI8Bs8YJHveGDD24tXCYybN23YYrIU5x+Awg8ENoC28hLX8Bzns8WeQFnugFsa/hLUcAGlhkAbbIpFjwIzflrRiY962ZB42nmdm0n8MDvNInHlWcFjmHG4ths2HNz7mbbOT42dPfvxxxp/DcvztyRsfvinDo6UBxhJIAFM8IOIAbg0MDPJwFj9edaNgFIyCUTCSAQDvcEbvoTZHDQAAAABJRU5ErkJggg==","orcid":"","institution":"Swinburne University of Technology","correspondingAuthor":true,"prefix":"","firstName":"Jennifer","middleName":"","lastName":"Donnelly","suffix":""},{"id":593423409,"identity":"81b6d98e-b718-4ed1-a2a9-ed60a326d985","order_by":1,"name":"Adam Brook","email":"","orcid":"","institution":"St Vincent's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Adam","middleName":"","lastName":"Brook","suffix":""},{"id":593423410,"identity":"b986b929-220e-4e86-8d85-d97ce311b26d","order_by":2,"name":"Gavin Wright","email":"","orcid":"","institution":"St Vincent's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Gavin","middleName":"","lastName":"Wright","suffix":""}],"badges":[],"createdAt":"2026-02-08 22:23:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8824381/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8824381/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s11701-026-03362-0","type":"published","date":"2026-04-01T15:59:26+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":106344580,"identity":"8efdc57a-e9e9-4c2a-bb60-d03574dc1cda","added_by":"auto","created_at":"2026-04-07 16:15:53","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1172998,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8824381/v1/9c849ec2-6eb2-4928-9339-6236aa109519.pdf"},{"id":102993714,"identity":"7bddd61d-af92-4cb5-b285-54063cfb139c","added_by":"auto","created_at":"2026-02-19 11:51:26","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":224651,"visible":true,"origin":"","legend":"","description":"","filename":"Supplement1SurveyClinicalTrialsExperiences.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8824381/v1/bd068673c74b9d4fb646ec38.pdf"},{"id":102993713,"identity":"236d1c22-fa39-4c20-89ee-bfc9c43076b9","added_by":"auto","created_at":"2026-02-19 11:51:26","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":16991,"visible":true,"origin":"","legend":"","description":"","filename":"Supplement2Semistructuredinterviewguide.docx","url":"https://assets-eu.researchsquare.com/files/rs-8824381/v1/9391cedb326897dafe0f183b.docx"},{"id":102993716,"identity":"3f681765-be9d-478f-93b8-1019ef853f87","added_by":"auto","created_at":"2026-02-19 11:51:26","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":14719,"visible":true,"origin":"","legend":"","description":"","filename":"GRAMMSMixedmethodClinicaltrialsexperiences.docx","url":"https://assets-eu.researchsquare.com/files/rs-8824381/v1/d6dac4f64157ea44bfc95ef1.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Patient experiences in trials of minimally invasive thoracic surgery: A mixed-methods study","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eLung cancer remains the leading cause of cancer-related mortality worldwide [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The surgical management of pulmonary malignancies has undergone a significant paradigm shift since the introduction of the da Vinci surgical system (Intuitive Surgical, Sunnyvale, CA), with robotic-assisted thoracic surgery and video-assisted thoracic surgery emerging as standard minimally invasive approaches [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eRobotic platforms offer technical advantages including tremor elimination, increased degrees of freedom, superior surgeon ergonomics, and enhanced three-dimensional visualization [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. These advantages translate to clinical benefits: large-scale database analyses and systematic reviews have demonstrated that robotic-assisted lobectomy is associated with lower perioperative morbidity, reduced 30-day mortality, and fewer early postoperative complications compared to open thoracotomy, with comparable long-term survival [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe present study drew participants from two clinical trials investigating advanced monitoring and imaging technologies:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cem\u003eThe DURATION Trial\u003c/em\u003e: This protocol uses droplet digital PCR to track circulating tumor DNA (ctDNA) in patients\u0026rsquo; blood, enabling detection of molecular signs of cancer recurrence after minimally invasive lung cancer resection.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cem\u003eThe VGT-309 Trials\u003c/em\u003e: These protocols evaluate abenacianine, an imaging agent that, when injected before surgery, causes tumor cells to fluoresce under near-infrared light, aiding localization and more precise identification of cancer margins.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eWhile the safety and feasibility of robotic platforms and established imaging adjuncts are well-documented [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], patient experiences within complex trial frameworks remain under-explored. Prior studies of patient experiences in experimental oncology trials suggest that decision-making is often influenced by a strong desire for personal benefit, leading patients to emphasize potential gains over risks; many participants also express a need for clearer, simplified information to better understand the trial\u0026rsquo;s primary scientific purpose versus its clinical limitations [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eResearch into patient perceptions of surgical innovation remains remarkably sparse. While many patients associate robotic-assisted platforms with advanced precision and faster recovery, these views are often shaped more by marketing language than by clinical evidence [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Prior research also indicates that patients may harbor anxieties about robotic surgery, including concerns about equipment reliability and reduced surgeon involvement [\u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Understanding how these perceptions influence trial participation remains important for optimizing recruitment.\u003c/p\u003e \u003cp\u003eThis study aims to evaluate patient experiences of robotic-assisted and video-assisted thoracic surgery within clinical trial settings. The question addressed here - which remains unaddressed in the medical literature - is how patients perceive being on a clinical trial when they have a life-threatening illness and are being treated with advanced surgical modalities. The answer will be of interest to physicians deciding whether to refer patients to clinical trials, and to those wishing to conduct trials involving life-threatening illnesses and advanced surgical techniques.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design and Ethical Oversight\u003c/h2\u003e \u003cp\u003eThis mixed-methods study combined quantitative survey data with qualitative insights from semi-structured interviews to develop a nuanced understanding of the patient experience. The study protocol received institutional review board approval from the St. Vincent\u0026rsquo;s Hospital Melbourne Research Ethics Committee (Approval No. 086/25). The research team included academics, thoracic surgeons, and clinical trial coordinators with expertise in qualitative and quantitative methods.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSetting and Participant Selection\u003c/h3\u003e\n\u003cp\u003eThe recruitment base comprised patients enrolled in the \u003cem\u003eDURATION\u003c/em\u003e (ddPCR; HREC 168.18) and \u003cem\u003eVERGENT\u003c/em\u003e (VGT-309; HREC 051.21 and VGT-309 2B; HREC 076.24) trials who underwent either robotic-assisted or video-assisted thoracic surgery (VATS) at St. Vincent\u0026rsquo;s Hospital Melbourne or St. Vincent\u0026rsquo;s Private Hospital Melbourne. To be eligible, participants were required to be 18 years of age or older and proficient in English. Vulnerable populations, including Aboriginal and Torres Strait Islander Peoples, were excluded from this specific sub-study.\u003c/p\u003e\n\u003ch3\u003eRecruitment and Consent\u003c/h3\u003e\n\u003cp\u003e Eligible participants were initially contacted via telephone to gauge interest, followed by an email containing a link to a digital survey with an embedded information and consent form. For the qualitative component, purposive sampling was employed to ensure a diverse representation of age, sociodemographic status, and gender to reduce confounding factors. These participants were invited via telephone for a semi-structured interview, with formal consent materials provided electronically or via post. Interviews were scheduled at the participant\u0026rsquo;s convenience and conducted face-to-face, via telephone, or through videoconferencing.\u003c/p\u003e\n\u003ch3\u003eData Collection\u003c/h3\u003e\n\u003cp\u003e \u003cem\u003eQuantitative Survey\u003c/em\u003e: An estimated 10\u0026ndash;15 minute patient experience survey was developed in REDCap, informed by established frameworks for assessing the research participant experience [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. The instrument explored patient perspectives across three domains: (1) pre-trial expectations, (2) peri-trial experiences, and (3) perceived collaboration with the research and healthcare teams (Supplement 1).\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eQualitative Interviews\u003c/strong\u003e \u003cp\u003eOne-on-one semi-structured interviews (approximately 15\u0026ndash;20 minutes) were audio-recorded. An interview guide with open-ended questions was developed to explore participant experiences in depth (Supplement 2). Participants were given the opportunity to review their responses prior to analysis; no changes were requested.\u003c/p\u003e \u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003e \u003cstrong\u003eQuantitative Analysis\u003c/strong\u003e \u003cp\u003eSurvey data were exported from REDCap and analyzed using descriptive statistics in SPSS Statistics version 31.0.1 [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eQualitative Analysis\u003c/strong\u003e \u003cp\u003eAudio recordings were transcribed verbatim and analyzed using thematic analysis [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Two researchers (JD and AB) independently coded the data in ATLAS.ti Web [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Themes and subthemes were developed through discussion until consensus was reached. This independent process was maintained until a final consensus was reached on the thematic framework, ensuring methodological rigor and inter-rater reliability. This mixed method study was reported in accordance with the Good Reporting of a Mixed Method Study (GRAMMS) checklist [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eParticipant Characteristics\u003c/h2\u003e \u003cp\u003eA total of 26 participants completed the quantitative survey. The cohort was nearly evenly distributed by gender (53.8% women, 46.2% men) and primarily represented an older demographic, with 65.4% of participants aged 65 years or older. Most participants were retired (n\u0026thinsp;=\u0026thinsp;17, 65.4%), while 8 (30.8%) remained in the workforce. The majority of the cohort (61.5%) had no prior experience with clinical trial participation.\u003c/p\u003e \u003cp\u003e Of the 25 participants invited for a semi-structured interview, 16 consented and completed the session (64.0% response rate). The interview sub-cohort mirrored the broader survey population regarding gender (50.0% women) and age (62.5% aged\u0026thinsp;\u0026gt;\u0026thinsp;65 years). Detailed participant demographics are provided in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics of participants who completed a semi-structured interview (n\u0026thinsp;=\u0026thinsp;16) or survey (n\u0026thinsp;=\u0026thinsp;26)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSemi-structured interviews n (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSurvey n (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWomen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8 (50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14 (53.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8 (50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12 (46.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge (years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e35\u0026ndash;54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3 (18.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3 (11.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e55\u0026ndash;64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3 (18.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6 (23.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e65\u0026ndash;74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6 (37.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10 (38.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e75+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4 (25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7 (26.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEmployment Type\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmployed/Self-Employed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5 (31.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8 (30.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRetired\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10 (62.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17 (65.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther/Unemployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 (6.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1 (3.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eQuantitative Survey Results\u003c/h3\u003e\n\u003cp\u003eSurvey results are organized into three key areas: enrollment motivations, satisfaction and clinical outcomes, and future participation intentions.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eTrial Enrollment and Motivations\u003c/h2\u003e \u003cp\u003e Participants reported high levels of satisfaction with the pre-trial enrollment process; 100% agreed they received all necessary information and felt comfortable asking questions prior to consent. Primary motivations for enrollment (respondents could select multiple) included:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eScientific Advancement: 100% aimed to help advance science for lung cancer treatment.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eAltruism: 80.8% sought to help future patients suffering from lung cancer.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003ePersonal Benefit: 61.5% hoped to obtain superior treatment for their own condition.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eSatisfaction and Clinical Outcomes\u003c/h2\u003e \u003cp\u003eOverall satisfaction with the clinical trial was 100%. Specific high-satisfaction metrics included the surgical experience (100%), care provided by hospital-based trial staff (96.2%), and information regarding post-trial support (84.7%). Participants perceived the trial as both beneficial and low burden. 96.1% felt they had contributed meaningfully to medical research, and 84.6% reported an improved quality of life. Furthermore, 84.7% of participants disagreed that the trial was time-consuming or interfered with their daily routines.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eFuture Participation and Recommendations\u003c/h2\u003e \u003cp\u003eEngagement levels remained high regarding future research; 88.5% of respondents indicated a willingness to participate in a future randomized clinical trial (RCT) should there be no clear \u0026ldquo;gold standard\u0026rdquo; treatment. Additionally, 96.2% stated they would recommend participation in this specific study or future trials conducted by this research team.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eQualitative Interview Results\u003c/h2\u003e \u003cp\u003eThematic analysis of the semi-structured interviews yielded fifteen themes and seven sub-themes organized across seven core domains. These findings provide a deeper understanding of the survey data, detailing the nuanced experiences and perceptions of the participants. A summary of these domains, themes, and sub-themes, accompanied by illustrative participant quotes, is presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Detailed findings for each domain are presented below.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eQualitative Domains, Themes, and Representative Quotes Regarding Patient Experiences in Minimally Invasive Thoracic Surgery Clinical Trials.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTheme\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSubtheme\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRepresentative Quote\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eDomain 1: Motivations and Influences Regarding Enrollment\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAltruistic Motivations\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDesire to contribute to medical knowledge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026ldquo;You feel good. You\u0026rsquo;re helping other people.\u0026rdquo; (ID06)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eExpectation of Superior Care\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePerceived advantage of specialized oversight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026ldquo;The doctor comes, or the trial people come, and you sort of felt at ease because \u0026hellip; you had a lot of people looking after you.\u0026rdquo; (ID03)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRisk-Benefit Appraisal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePersonal health goals vs. trial objectives\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026ldquo;I was very comfortable going along with it. It was just hopefully a tool that would aid the surgeon and I was all for that.\u0026rdquo; (ID10)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFoundational Trust\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eConfidence in study protocol and surgical expertise\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026ldquo;If somebody talks to me about a trial and it seems to me that it makes sense, then I'll definitely do it.\u0026rdquo; (ID01)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDomain 2: Communication from the Clinical Trials Team\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eProtocol and Consent Clarity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTransparency of study procedures\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026ldquo;They sort of explained everything really well.\u0026rdquo; (ID03)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eStaff Attentiveness and Empathy\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReassurance through clinical team rapport\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026ldquo;I just remember the clinical trial staff as being very thorough and pleasant \u0026hellip; they were certainly reassuring.\u0026rdquo; (ID04)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDomain 3: Influences on the Decision to Undergo Surgery\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eSurgeon-Related Influences\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTrust in the surgeon\u0026rsquo;s expertise\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026ldquo;I felt 100% confident with [surgeon\u0026rsquo;s name].\u0026rdquo; (ID07)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReferring doctors\u0026rsquo; endorsement of the surgeon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026ldquo;[Surgeon\u0026rsquo;s name] was referred to me by my own personal doctor out here who knew him.\u0026rdquo; (ID07)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSurgeon\u0026rsquo;s communication style and explanations boosted confidence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026ldquo;The trial was explained to me very clearly \u0026hellip; I was very comfortable going along with it.\u0026rdquo; (ID10)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePerceptions of Surgical Modality and Outcomes\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePerceived procedural advantages (e.g., precision, rapid recovery)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026ldquo;[It\u0026rsquo;s] very precise, so I was sort of with ease after that.\u0026rdquo; (ID03)\u003c/p\u003e \u003cp\u003e\u0026ldquo;It would be a lot more steady for the surgeon. There\u0026rsquo;s no shaking, there\u0026rsquo;s no ifs and buts, it\u0026rsquo;s very clean in and out.\u0026rdquo; (ID06)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDomain 4: Expectations of Surgery within the Clinical Trial\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eCongruence of Surgical Expectations and Clinical Outcomes\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePerceived clinical benefits of surgical resection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026ldquo;It wasn't just the central lobe, which was the prediction, but it was something in the lower lobe \u0026hellip; They discovered extra areas they needed to take out.\u0026rdquo; (ID14)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePositive recovery trajectory and minimal procedural burden\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026ldquo;Normally after these robotic surgeries, they\u0026rsquo;re all fine. I recover very quickly.\u0026rdquo; (ID01)\u003c/p\u003e \u003cp\u003e\u0026ldquo;Because it\u0026rsquo;s less invasive \u0026hellip; you\u0026rsquo;re not sliced open so much.\u0026rdquo; (ID02)\u003c/p\u003e \u003cp\u003e\u0026ldquo;You\u0026rsquo;re going and get a lung operation to get cancer removed overnight and come home. There\u0026rsquo;s not much to complain about \u0026hellip; It\u0026rsquo;s a bit of a no-brainer.\u0026rdquo; (ID06)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDomain 5: Postoperative Care and Follow-up\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eContinuity of Support\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAccessibility of trial-specific support staff\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026ldquo;I had numbers to ring, but I didn\u0026rsquo;t need to talk to anyone to tell you the truth.\u0026rdquo; (ID07)\u003c/p\u003e \u003cp\u003e\u0026ldquo;Really positive. I felt like I was in really good hands. I had strong communication. [The clinical trials nurse] gave me her mobile number and got in contact, you know, frequently post that meeting as well as to next steps.\u0026rdquo; (ID11)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAdequacy of Follow-up Protocols\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePerceived adequacy of postoperative monitoring\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026ldquo;Afterwards \u0026hellip; blood tests and the ECGs and then \u0026hellip; a couple of phone calls after. So, it wasn\u0026rsquo;t very, it wasn\u0026rsquo;t very involved.\u0026rdquo; (ID02)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDomain 6: Challenges to Clinical Trial Participation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePerioperative Anxiety Management\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNormalization of perioperative apprehension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026ldquo;I would understand nervousness ... it wasn't long before I was back to normal again.\u0026rdquo; (ID16)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLogistical and Time Commitments\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMinimal impact of trial-related time commitments\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026ldquo;I understand it\u0026rsquo;s to help other people as well as myself. I was treated really well \u0026hellip; I went back quite a few times with blood tests done and testing the heart \u0026hellip; and [it] wasn\u0026rsquo;t really any interruption in my time.\u0026rdquo; (ID06)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDomain 7: Overall Experience\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePerceived Continuity and \u0026ldquo;Seamlessness\u0026rdquo;\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePerceived ease of the surgical journey\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026ldquo;It was very seamless.\u0026rdquo; (ID10)\u003c/p\u003e \u003cp\u003e\u0026ldquo;It was a really easy, positive experience.\u0026rdquo; (ID13)\u003c/p\u003e \u003cp\u003e\u0026ldquo;I can't believe I had some of my lung taken out, and I can't tell ... You can hardly see the scars. The little things. It\u0026rsquo;s just unbelievable.\u0026rdquo; (ID07)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePropensity for Future Participation and Advocacy\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWillingness to advocate for clinical research\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026ldquo;I would say give it, give it a go... my experience... it wasn't long before I was back to normal again.\u0026rdquo; (ID16)\u003c/p\u003e \u003cp\u003e\u0026ldquo;If you can get more advanced medical care, definitely.\u0026rdquo; (ID06)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003e\u003cb\u003eNote\u003c/b\u003e: ID, participant identification number; ECG, electrocardiogram. Brackets [ ] indicate text added or modified for clarity or de-identification. Ellipses (...) indicate omitted text for brevity.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eDOMAIN 1: MOTIVATIONS AND INFLUENCES REGARDING ENROLLMENT\u003c/h2\u003e \u003cp\u003eParticipants were motivated to enroll by a convergence of altruistic intent and personal benefit, viewing trial participation as both a contribution to medical progress and an opportunity to access specialized care. These motivations were reinforced by foundational trust in the research protocol, surgical team, and institution. A prominent driver was the desire to advance medical science and help future patients. Participants viewed their involvement as personally meaningful even while facing a life-threatening diagnosis, with one noting: \u0026ldquo;I just thought it was important to me personally... to get the cancer removed for a start, but... to understand that I\u0026rsquo;m helping in some small way, helping advance a bit of science.\u0026rdquo; (ID12).\u003c/p\u003e \u003cp\u003e Beyond altruism, participants anticipated that trial enrollment would provide access to enhanced medical attention, describing it as an opportunity to receive \u0026ldquo;the most advanced thing at the moment, which means I'm getting the best of care\u0026rdquo; (ID06). The perception of low risk and high potential benefit made enrollment appear both logical and appealing. Foundational trust was critical. Endorsements from referring physicians played a significant role, as did the surgeon's communication style. Trust extended to the institution itself, with participants expressing confidence that any trial conducted within the hospital would be managed with appropriate clinical rigor.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eDOMAIN 2: COMMUNICATION FROM THE CLINICAL TRIALS TEAM\u003c/h2\u003e \u003cp\u003e Participants consistently described interactions with clinical trial staff as clear, thorough, and supportive. Information regarding the study protocol and consent process was communicated transparently, with participants receiving detailed written materials and being encouraged to consult with family members and personal physicians before providing consent. Interactions with staff were characterized by professionalism, empathy, and attentiveness. Even those with minimal contact found reassurance in knowing support was readily accessible. Overall, participants described their engagement with the clinical trials team as aligning with expectations for pleasant, supportive, and professional care.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eDOMAIN 3: INFLUENCES ON THE DECISION TO UNDERGO SURGERY\u003c/h2\u003e \u003cp\u003eThe decision to undergo minimally invasive surgery was shaped by three factors: trust in the surgeon\u0026rsquo;s expertise, endorsements from referring physicians, and favorable perceptions of the surgical modality. Trust in the surgeon was central. Participants emphasized the importance of the surgeon\u0026rsquo;s specialized skills, with professional endorsement from referring doctors providing critical reassurance. One participant explained: \u0026ldquo;[Surgeon's name] was referred to me by my own personal doctor out here who knew him, and I just did not have any concerns at all about what he was going to do with robotics\u0026rdquo; (ID07).\u003c/p\u003e \u003cp\u003eRobotic-assisted and video-assisted surgery were widely viewed as offering superior precision and outcomes compared to open surgery. Participants anticipated faster recovery and minimal physical burden, with one characterizing it as \u0026ldquo;a bit of a no-brainer\u0026rdquo; (ID06). These perceptions were reinforced by independent research, testimonials, and confidence in Australia\u0026rsquo;s healthcare safety standards.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eDOMAIN 4: EXPECTATIONS OF SURGERY WITHIN THE CLINICAL TRIAL\u003c/h2\u003e \u003cp\u003eParticipants\u0026rsquo; expectations were largely met or exceeded, with many reporting outcomes that surpassed initial anticipations. Recovery was characterized by short hospital stays, minimal pain, and rapid return to normal activities. One participant reflected: \u0026ldquo;I can\u0026rsquo;t believe I had some of my lung taken out, and I can\u0026rsquo;t tell... you can hardly see the scars... It\u0026rsquo;s just unbelievable\u0026rdquo; (ID07).\u003c/p\u003e \u003cp\u003eParticipants identified specific clinical benefits from trial participation, particularly regarding tumor detection. Several reported that more lesions were identified and resected than anticipated based on preoperative imaging: \u0026ldquo;It lights up the tumour and there\u0026rsquo;s this nice big bright green spot and he said we got that and by the way we\u0026rsquo;ve got two others as well that they found\u0026rdquo; (ID01). Overall, the trial framework was seen as enhancing rather than complicating the surgical experience.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eDOMAIN 5: POSTOPERATIVE CARE AND FOLLOW-UP\u003c/h2\u003e \u003cp\u003ePostoperative care was described as straightforward and supportive. Having direct access to clinical trial staff provided significant reassurance, regardless of whether participants actively utilized this support. The variability in follow-up intensity reflected individual needs, with participants expressing satisfaction that support was appropriately tailored to their recovery trajectories.\u003c/p\u003e \u003cp\u003eFollow-up comprised standard surgical procedures including reviews with the surgeon and calls from trial coordinators. This low burden was viewed positively, as trial-related requirements did not impose significant demands beyond standard postoperative care. Minor complications were perceived as resolving over time and within expectations previously outlined by the surgical team.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eDOMAIN 6: CHALLENGES TO CLINICAL TRIAL PARTICIPATION\u003c/h2\u003e \u003cp\u003eChallenges were characterized as minor inconveniences rather than significant barriers. Perioperative anxiety was acknowledged but viewed as a standard aspect of undergoing surgery rather than trial-specific. Confidence in the surgical team and the minimally invasive approach mitigated much of this anxiety.\u003c/p\u003e \u003cp\u003eLogistical demands posed only minor hurdles. One participant described the pre-surgical day as \u0026ldquo;tedious\u0026rdquo; but \u0026ldquo;not difficult\u0026rdquo; (ID01). Time commitments were generally perceived as manageable and justified by anticipated benefits. Hospital parking was mentioned by some as a minor inconvenience but not a substantial barrier.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eDOMAIN 7: OVERALL EXPERIENCE\u003c/h2\u003e \u003cp\u003eParticipants reported an overwhelmingly positive experience, frequently characterizing the process as straightforward, seamless, and personally meaningful. The integration of trial procedures into standard surgical care was found unobtrusive and well-coordinated. All participants indicated willingness to enroll in future clinical trials, provided the protocol is appropriate and scientifically sound. Responses regarding recommending trial participation were uniformly positive, though participants emphasized the importance of critically evaluating information before consenting. Altruism emerged as a sustained motivator throughout, with participants expressing satisfaction that their involvement could benefit future patients.\u003c/p\u003e \u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis mixed-methods study explored the experiences of participants enrolled in clinical trials involving \u003cem\u003erobotic-assisted surgery or VATS\u003c/em\u003e across two tertiary centers in Melbourne, Australia. To our knowledge, this is the first study to examine patient satisfaction when advanced surgical modalities are combined with clinical research protocols. The findings demonstrate that patients are highly satisfied with trial participation because the experience directly aligns with their primary motivations for enrolling: advancing science, altruism, and personal benefit.\u003c/p\u003e \u003cp\u003eParticipant satisfaction was underpinned by three factors:\u003c/p\u003e \u003cp\u003eFirst, the desire for better treatment was met by deep trust in the surgeon\u0026rsquo;s expertise and the perceived precision of fluorescence-guided surgery. The use of fluorescent imaging acted as a \u0026ldquo;technological GPS,\u0026rdquo; reassuring patients that their tumors were being identified and resected with more accuracy than the naked eye. Structured pre-operative education and transparent communication were pivotal in fostering this confidence, aligning with previous research highlighting the positive impact of clear information on patient perceptions in robotic-assisted surgery [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], other surgical contexts [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], and clinical trials broadly [\u003cspan additionalcitationids=\"CR20\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSecond, participants appreciated the rigorous surveillance inherent to trial protocols. In the \u003cem\u003eDURATION study\u003c/em\u003e, knowing their progress was being monitored more frequently than in standard care provided a sense of security. This perception that trial participation offers superior care is consistent with prior research [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThird, the altruistic goal of helping others\u0026mdash;consistent with prior research on trial motivations [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u0026mdash;was supported by an experience participants frequently characterized as \u0026ldquo;\u003cem\u003eseamless\u003c/em\u003e\u0026rdquo;. Minimal surgical discomfort and faster recovery through minimally invasive approaches allowed participants to contribute to medical progress without undue physical burden.\u003c/p\u003e \u003cp\u003eThese results suggest that physicians should not hesitate to enroll patients in appropriate trials featuring novel technology. The perceived risk of the \u0026ldquo;unknown\u0026rdquo; is outweighed by patients\u0026rsquo; desire to advance science and the reassurance provided by an empathetic clinical trials team. Future studies should examine whether these findings generalise to other surgical specialties, diverse patient populations, and different types of technological innovation.\u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section2\"\u003e \u003ch2\u003eStrengths and Limitations\u003c/h2\u003e \u003cp\u003eA primary strength of this study is the mixed-methods design, which combined quantitative survey data with qualitative interviews to yield a nuanced understanding of patient experiences. The qualitative component provided deep insight into motivations, trust, communication, and perceptions of surgical innovation.\u003c/p\u003e \u003cp\u003eThis study has several limitations. First, the self-reported nature of both surveys and interviews may introduce social desirability bias, with participants potentially overstating satisfaction. Second, the cohort was drawn from a single geographic region (Melbourne) and comprised predominantly older, retired individuals, which may limit generalisability to younger or working populations. Third, only participants who completed the trial were included, potentially excluding those with negative experiences who withdrew. Fourth, the focus on lung cancer resections within specific trial protocols may not reflect experiences in other surgical specialties or trial designs.\u003c/p\u003e \u003c/div\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThis study demonstrates that participants undergoing \u003cem\u003erobotic-assisted surgery or VATS\u003c/em\u003e within a clinical trial framework report overwhelmingly positive experiences, often describing the perioperative journey as \u0026ldquo;\u003cem\u003eseamless\u003c/em\u003e\u0026rdquo;. This high level of satisfaction is driven by a desire to advance scientific knowledge and a perception that trial participation offers superior clinical precision and rigorous monitoring.\u003c/p\u003e \u003cp\u003eThe findings provide strong support for enrolling patients in appropriate clinical trials involving advanced surgical technology. Participants viewed technical innovation and trial-specific surveillance not as burdens, but as significant sources of reassurance and personal benefit. By integrating patient-centered communication with advanced surgical platforms, clinical trials can provide an experience that meets, and often exceeds, the expectations of patients navigating a life-threatening diagnosis.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding Source:\u0026nbsp;\u003c/strong\u003eThe authors declare that no funds, grants, or other support were received during the preparation of this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Approval:\u0026nbsp;\u003c/strong\u003eThis study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by St. Vincent’s Hospital Human Research Ethics Committee (Approval No. 086/25). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003eJ.D., A.B. and G.W. contributed to the design. J.D. completed data collection. J.D. and A.B. completed formal analysis. All authors participated in writing, reviewing and editing of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest statement:\u0026nbsp;\u003c/strong\u003eNo conflict of interests to be declared.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSiegel RL, Miller KD, Wagle NS, Jemal A (2023) Cancer statistics. CA Cancer J Clin 73(1):17-48. https://doi.org/10.3322/caac.21763\u003c/li\u003e\n\u003cli\u003eSung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. (2021) Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin 71(3):209-49. https://doi.org/10.3322/caac.21660\u003c/li\u003e\n\u003cli\u003eOh DS, Reddy RM, Gorrepati ML, Mehendale S, Reed MF (2017) Robotic-Assisted, Video-Assisted Thoracoscopic and Open Lobectomy: Propensity-Matched Analysis of Recent Premier Data. Ann Thorac Surg 104(5):1733-40. https://doi.org/10.1016/j.athoracsur.2017.06.020\u003c/li\u003e\n\u003cli\u003eLevy JS, Gharagozloo F (2021) Development of the fundamentals of thoracic robotic surgery curriculum. J Thorac Dis 13(10):6116-22. https://doi.org/10.21037/jtd-2019-rts-02\u003c/li\u003e\n\u003cli\u003eO\u0026apos;Sullivan KE, Kreaden US, Hebert AE, Eaton D, Redmond KC (2019) A systematic review and meta-analysis of robotic versus open and video-assisted thoracoscopic surgery approaches for lobectomy. Interact Cardiovasc Thorac Surg 28(4):526-34. https://doi.org/10.1093/icvts/ivy315\u003c/li\u003e\n\u003cli\u003eAiolfi A, Nosotti M, Micheletto G, Khor D, Bonitta G, Perali C, Marin J, Biraghi T, Bona D (2021) Pulmonary lobectomy for cancer: Systematic review and network meta-analysis comparing open, video-assisted thoracic surgery, and robotic approach. Surgery 169(2):436-46. https://doi.org/10.1016/j.surg.2020.09.010\u003c/li\u003e\n\u003cli\u003eOkusanya OT, DeJesus EM, Jiang JX, Judy RP, Venegas OG, Deshpande CG, et al. (2015) Intraoperative molecular imaging can identify lung adenocarcinomas during pulmonary resection. J Thorac Cardiovasc Surg 150(1):28-35.e1. https://doi.org/10.1016/j.jtcvs.2015.05.014\u003c/li\u003e\n\u003cli\u003eSawyer C, Preston L, Taylor S, Davies M, Carter L, Krebs M, et al. (2021) Oncology patients\u0026apos; experiences in experimental medicine cancer trials: a qualitative study. BMJ Open 11(10):e047813. https://doi.org/10.1136/bmjopen-2020-047813\u003c/li\u003e\n\u003cli\u003eJauniaux B, Anand A, Abbas R, Harji DP (2025) From expectations to experiences: a systematic review of patient and public perspectives on robotic surgery. J Robot Surg 19(1):484. https://doi.org/10.1007/s11701-025-02649-y\u003c/li\u003e\n\u003cli\u003eChu CM, Agrawal A, Mazloomdoost D, Barenberg B, Dune TJ, Pilkinton ML, et al. (2019) Patients\u0026apos; Knowledge of and Attitude Toward Robotic Surgery for Pelvic Organ Prolapse. Female Pelvic Med Reconstr Surg 25(4):279-83. https://doi.org/10.1097/spv.0000000000000556\u003c/li\u003e\n\u003cli\u003ePagani NR, Moverman MA, Puzzitiello RN, Menendez ME, Barnes CL, Kavolus JJ (2021) Online Crowdsourcing to Explore Public Perceptions of Robotic-Assisted Orthopedic Surgery. J Arthroplasty 36(6):1887-94.e3. https://doi.org/10.1016/j.arth.2021.02.027\u003c/li\u003e\n\u003cli\u003eKost RG, Lee LM, Yessis J, Coller BS, Henderson DK (2011) Assessing research participants\u0026apos; perceptions of their clinical research experiences. Clin Transl Sci 4(6):403-13. https://doi.org/10.1111/j.1752-8062.2011.00349.x\u003c/li\u003e\n\u003cli\u003eIBM Corp. (2025) IBM SPSS Statistics for Windows (Version 31.0.1) [Computer software] Armonk, NY: IBM Corp. Available from: https://www.ibm.com/support/pages/downloading-ibm-spss-statistics-31.\u003c/li\u003e\n\u003cli\u003eBraun V, Clarke V (2006) Using thematic analysis in psychology. Qual Res Psychol 3(2):77-101. https://doi.org/10.1191/1478088706qp063oa\u003c/li\u003e\n\u003cli\u003eATLAS.ti Scientific Software Development GmbH (2023) ATLAS.ti [Computer program]. Version 23.2.1 Berlin: ATLAS.ti Scientific Software Development GmbH. Available from: https://atlasti.com\u003c/li\u003e\n\u003cli\u003eO\u0026apos;Cathain A, Murphy E, Nicholl J (2008) The quality of mixed methods studies in health services research. J Health Serv Res Policy 13(2):92-8. https://doi.org/10.1258/jhsrp.2007.007074\u003c/li\u003e\n\u003cli\u003eHannah C, Eriksson LE, Ramwell A, Llahana S (2025) Experiences and perspectives of patients undergoing colorectal cancer surgery: A qualitative study. Eur J Oncol Nurs 74:102794. https://doi.org/10.1016/j.ejon.2025.102794\u003c/li\u003e\n\u003cli\u003eMickan S, Fletcher J, Burrows R, Bateup S, Stokes A, Tsung J (2024) Reporting patient experiences within elective perioperative care: a scoping review. Int J Qual Health Care 36(3):mzae085. https://doi.org/10.1093/intqhc/mzae085\u003c/li\u003e\n\u003cli\u003ePhelps EE, Tutton E, Griffin X, Baird J (2020) A mixed-methods systematic review of patients\u0026apos; experience of being invited to participate in surgical randomised controlled trials. Soc Sci Med 253:112961. https://doi.org/10.1016/j.socscimed.2020.112961\u003c/li\u003e\n\u003cli\u003eRobertson EG, Mitchell R, Wakefield CE, Lewis P, Cousens N, Marshall GM, et al. (2019) Enrolment in paediatric oncology early-phase clinical trials: The health-care professionals\u0026apos; perspective. J Paediatr Child Health 55(5):561-6. https://doi.org/10.1111/jpc.14248\u003c/li\u003e\n\u003cli\u003eEllis JA, Malalasekera VS, Allan C, Choong PF, Hansford JR, Hehir R, et al. (2022) Systems-Level Change to Alleviate Barriers to Cancer Clinical Trial Access for Adolescents and Young Adults in Australia. J Adolesc Young Adult Oncol 11(2):173-80. https://doi.org/10.1089/jayao.2021.0026\u003c/li\u003e\n\u003cli\u003eAnderson A, Borfitz D, Getz K (2018) Global Public Attitudes About Clinical Research and Patient Experiences With Clinical Trials. JAMA Netw Open 1(6):e182969. https://doi.org/10.1001/jamanetworkopen.2018.2969\u003c/li\u003e\n\u003cli\u003eTruong TH, Weeks JC, Cook EF, Joffe S (2011) Altruism among participants in cancer clinical trials. Clinical Trials 8(5):616-23. https://doi.org/10.1177/1740774511414444\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-robotic-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jors","sideBox":"Learn more about [Journal of Robotic Surgery](http://link.springer.com/journal/11701)","snPcode":"11701","submissionUrl":"https://submission.nature.com/new-submission/11701/3","title":"Journal of Robotic Surgery","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"robotic-assisted surgery, video-assisted thoracic surgery (VATS), lung cancer surgery, patient-reported outcomes, clinical trials, surgical innovation","lastPublishedDoi":"10.21203/rs.3.rs-8824381/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8824381/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eMinimally invasive thoracic surgery, including robotic-assisted and video-assisted approaches, is increasingly used to treat lung cancer. While technical outcomes are well documented, patient experiences within clinical trials remain under-explored.\u003c/p\u003e\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eTo evaluate patient experiences of clinical trial participation involving advanced surgical modalities for lung cancer.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis dual-center, mixed-methods study evaluated patient perceptions of participation in the DURATION (ctDNA monitoring) and VGT-309 (fluorescent imaging) trials. Twenty-six participants completed quantitative surveys assessing pre-trial expectations, experiences, and collaboration with research teams. Sixteen participants completed semi-structured interviews, analyzed using thematic analysis.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eTwenty-six participants completed surveys and sixteen completed interviews. Motivations for enrollment included advancing science (100%), altruism (80.8%), and personal benefit (61.5%). Satisfaction was universally high, with participants reporting positive surgical experiences, supportive staff interactions, and minimal procedural burden. Most participants (88.5%) expressed willingness to participate in future trials, and 96.2% would recommend trial involvement to others. Qualitative analysis identified seven domains characterizing patient experiences throughout the trial process: motivations for enrollment, communication from the trials team, influences on surgical decision-making, surgical expectations, postoperative care, challenges to participation, and overall experience. Challenges such as perioperative anxiety and logistical demands were minor and did not detract from overall satisfaction. Overall, participants described the trial experience as seamless and personally meaningful.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003ePatients undergoing robotic-assisted or video-assisted thoracic surgery within clinical trials report overwhelmingly positive experiences. The integration of patient-centered communication and advanced technology creates a seamless perioperative journey. Clinicians should not hesitate to enroll appropriate patients in trials featuring surgical innovations.\u003c/p\u003e","manuscriptTitle":"Patient experiences in trials of minimally invasive thoracic surgery: A mixed-methods study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-19 11:51:19","doi":"10.21203/rs.3.rs-8824381/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-02-25T11:48:52+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-25T05:50:11+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"20525624091030291407145885211552275310","date":"2026-02-18T15:38:40+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-18T13:57:23+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"214988159698361339058606575089491835960","date":"2026-02-18T12:45:22+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"151512377017862636286898877078663448980","date":"2026-02-16T13:09:12+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-16T12:29:15+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-11T19:10:33+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-11T06:53:09+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Robotic Surgery","date":"2026-02-08T22:14:57+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-robotic-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jors","sideBox":"Learn more about [Journal of Robotic Surgery](http://link.springer.com/journal/11701)","snPcode":"11701","submissionUrl":"https://submission.nature.com/new-submission/11701/3","title":"Journal of Robotic Surgery","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"1f58d318-c746-41fb-bdc5-ef91ae685d88","owner":[],"postedDate":"February 19th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-04-07T16:09:06+00:00","versionOfRecord":{"articleIdentity":"rs-8824381","link":"https://doi.org/10.1007/s11701-026-03362-0","journal":{"identity":"journal-of-robotic-surgery","isVorOnly":false,"title":"Journal of Robotic Surgery"},"publishedOn":"2026-04-01 15:59:26","publishedOnDateReadable":"April 1st, 2026"},"versionCreatedAt":"2026-02-19 11:51:19","video":"","vorDoi":"10.1007/s11701-026-03362-0","vorDoiUrl":"https://doi.org/10.1007/s11701-026-03362-0","workflowStages":[]},"version":"v1","identity":"rs-8824381","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8824381","identity":"rs-8824381","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}