Decoding patient preferences: key drivers in selecting thyroid cancer surgery- a discrete choice experiment

Objective With the growing application of the transoral endoscopic thyroidectomy vestibular approach (TOETVA) for papillary thyroid carcinoma (PTC), understanding patient preferences is critical to improving communication and supporting informed decision-making. This study aimed to identify key factors influencing surgical choices. Method A discrete choice experiment was conducted with patients diagnosed with PTC who were scheduled for thyroidectomy. Participants evaluated hypothetical surgical scenarios varying in six attributes: incision location, incision size, recurrence rate, operative duration, complication rate, and cost. Preferences and willingness to pay (WTP) were analyzed using a mixed logit model. Results A total of 271 patients were included in this study. Patients demonstrated a strong preference for surgical options with lower recurrence rates and scarless approaches. They were willing to pay an additional ¥201,409.60 to reduce the recurrence rate from 10% to 1% and ¥19,141.14 to change the surgical scar location from external to internal. The recurrence rate emerged as the most crucial non-financial factor (β = 8.18, P < 0.001, 95%), followed by incision location (β = 0.78, P < 0.001), and complication rate (β = 0.25, P = 0.030). Demographic factors such as gender, age, education level, marital status, and income exhibited notable differences in postoperative cosmetic concerns. Conclusion Recurrence risk is the primary driver of surgical preference in PTC patients, followed by cosmetic outcomes. Additionally, postoperative cosmetic concerns varied across different demographic groups. These findings highlight the need for surgeons to consider patient-specific values during preoperative consultations to enhance shared decision-making. Clinical Trial Registration https://www.chictr.org.cn/showproj.html?proj=191809 , identifier ChiCTR2300069048.