# Surrogate Decision-Making by Family Caregivers for Hyperthermic Intraperitoneal Chemotherapy in Gastric Cancer: Qualitative Study in a High-Volume Chinese Center

## TL;DR

This study explores how family caregivers in China make decisions about a chemotherapy treatment for gastric cancer patients, focusing on the challenges and information sources they use.

## Contribution

The study provides new insights into the decision-making process of family caregivers for HIPEC in gastric cancer, highlighting cultural and informational factors in a Chinese context.

## Key findings

- Family caregivers primarily engage in passive decision-making, often led by doctors.
- Information sources include medical staff, the internet, and personal networks.
- Challenges include financial concerns and uncertainty about treatment efficacy.

## Abstract

Hyperthermic intraperitoneal chemotherapy (HIPEC) has been integrated into the management of gastric cancer (GC) as a combined approach for addressing peritoneal metastasis, serving both prophylactic and therapeutic roles following GC surgery. The pivotal decision regarding HIPEC administration typically arises intraoperatively, creating a complex clinical scenario where family caregivers must act as surrogate decision-makers under substantial time constraints. This decision-making process proves particularly challenging due to limited understanding of the procedure’s risk-benefit profile and long-term outcomes among nonmedical surrogates, challenges often exacerbated by the acute stress of the surgical environment.

This qualitative study aims to explore how family caregivers of patients with GC navigate the HIPEC decision-making process, specifically examining the facilitators, challenges, and the role of information acquisition that shape the shared decision-making mode.

This study adopted a qualitative approach using semistructured interviews; 15 family caregivers of patients with GC in a major tertiary hospital in Guangxi Province were selected as research objects through a purposive sampling method. Participants were asked to comment on their experience of surrogate decision-making for the HIPEC process. The Colaizzi 7-step method was used to analyze and summarize the themes.

The mean age of the 15 participants was 39.8 (SD 13.29, range 20-68) years, and all patients were on average aged 56.7 (SD 10.78, range 36-74) years. The relationship to the patient was distributed as follows: 33% (5/15) spouses, 60% (9/15) children, and 6% (1/15) other relatives. Four major themes emerged from the data analysis: (1) shared decision-making participation mode (doctor-led passive decision-making and doctor-family shared decision-making); (2) decision-information sources (decision-making information came from medical-care personnel, decision-making information came from the internet, and decision-making information came from acquaintances); (3) challenges in the decision-making process (financial burden and anticipated therapeutic efficacy); and (4) facilitator in the decision-making process (positive health beliefs and cultural dimensions of perceived responsibility: a Confucian perspective).

HIPEC decision-making by family caregivers of patients with GC was primarily passive decision-making, and many obstacles and facilitators were encountered in the process. Medical staff should share information and encourage and guide family caregivers to participate in the decision-making process through decision assistance or decision support.