Observational study of decision making concerning radiotherapy in rectal cancer

• Cross-sectional study of majority of Australian and New Zealand Colorectal Surgeons.
• Insight into drivers of decision making in relation to rectal cancer and radiotherapy.
• Heuristic decisions can be biased by surgeon demographics.

AimTo understand how surgeons arrive at a decision in the complex and controversial field of radiotherapy in rectal cancer by identifying which variables are important in this decision and to assess the influence of age, training, area of practice and access to radiotherapy on decisions in this field.MethodsA self-administered survey was distributed to 150 members of the CSSANZ. They were asked to rank the importance of 33 variables considered when making decisions to use radiotherapy in the treatment of rectal cancer. The responses were assessed for association of surgeon age, area of practise or access to radiotherapy with decisions in this field.ResultsA hierarchy of variables was produced which showed tumour characteristics had the highest average importance, higher than that attained by patient characteristics and side effects.There were subtle but statistically significant differences in the ranking of importance when surgeons were grouped by age, site of subspeciality training, site of practise and availability of radiotherapy service.ConclusionThis study identifies a hierarchy of variables used in decision making concerning radiotherapy in rectal cancer treatment, which may be used in heuristic decision making.Decisions on using radiotherapy are influenced by age, site of practise, site of training, and the presence of radiotherapy on site.