Empirical study on psychosocial factors in liver cancer treatment: implications for medical student education in shared decision-making.

OBJECTIVE

To assess the impact of psychosocial factors on hepatocellular carcinoma (HCC) treatment decisions, guideline adherence, and patient survival, and to derive empirical insights for shared decision-making (SDM) training in medical education.

METHODS

In this single-center retrospective cohort study, we analyzed data from 1,928 patients with primary HCC. We collected baseline characteristics, psychosocial factors (payment method, psychological anxiety), treatment choices, and overall survival. Guideline adherence was determined based on the BCLC staging system.

RESULTS

Payment method and psychological anxiety were independent predictors of both treatment selection and guideline adherence (p < 0.05). Overall, only 49.95% of treatment decisions were guideline-adherent. Notably, while guideline-adherent management was associated with better overall survival (p = 0.02), a critical finding emerged in patients with intermediate-stage (BCLC-B) disease. In this subgroup, those treated contrary to guidelines demonstrated a significant survival advantage (p < 0.05).

CONCLUSION

Psychosocial factors are significant drivers of deviation from clinical guidelines in HCC care, creating a complex relationship with survival outcomes. The paradoxical survival benefit observed in non-adherent BCLC-B patients underscores the limitations of a one-size-fits-all guideline approach and highlights the necessity for individualized, patient-centered care. These findings provide a strong empirical foundation for integrating SDM and psychosocial assessment into medical curricula.