Patient perceptions of decision-making and quality-of-life following surgical resection of pancreatic adenocarcinoma: A mixed methods study

Abstract PURPOSE: Pancreatic adenocarcinoma (PDAC) remains a highly lethal disease. Surgery represents the only opportunity for cure, but is accompanied by high rates of morbidity. Understanding patients’ lived experiences after surgical resection of PDAC is critical to knowing whether the decision to undergo surgery was worth it for these patients.METHODS: We performed a convergent, mixed-methods study with patients who underwent resection of PDAC between 01/01/2019-08/01/2020. Quantitative data (medical record review and 3 questionnaires) were analyzed using descriptive statistics. Qualitative data (semi-structured interviews) were analyzed using the constant comparative method. Data were then compared for congruence.RESULTS: 18/22 eligible participants completed interviews and 11 completed questionnaires. Data collection occurred at a median of 14.2 months (IQR 11.6-16.3) from surgery. We identified 4 main themes. First, persistent negative symptoms were common for patients, but patients adapt to these and are satisfied with their “new normal.” Second, patients have varied and continually evolving mindsets throughout their cancer journey. Third, despite decreased quality-of-life, patients have a high degree of satisfaction with their decision to pursue surgery. Finally, patients were okay with a passive role in decision-making around surgery. Despite variable involvement in decision-making and outcomes, no participants reported regret over the decision to pursue surgery. CONCLUSION: This nuanced account of patients’ lived experiences following surgery for PDAC allows for an improved understanding of the impact of pancreatic resection on patients. Surgeons can use this data to improve preoperative counselling for patients with PDAC and help guide them to making the correct decisions about surgery.