{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T05:47:58Z","timestamp":1782712078933,"version":"3.54.5"},"reference-count":16,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T00:00:00Z","timestamp":1782691200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Payment method and psychological anxiety were independent predictors of both treatment selection and guideline adherence (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.05). Overall, only 49.95% of treatment decisions were guideline-adherent. Notably, while guideline-adherent management was associated with better overall survival (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.02), 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 (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1831463","type":"journal-article","created":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T05:40:08Z","timestamp":1782711608000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Empirical study on psychosocial factors in liver cancer treatment: implications for medical student education in shared decision-making"],"prefix":"10.3389","volume":"14","author":[{"given":"Minling","family":"Cao","sequence":"first","affiliation":[{"name":"Department of Hepatology, Guangdong Provincial Key Laboratory of Clinical Research on Traditional Chinese Medicine Syndrome, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ming","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Hepatology, Guangdong Provincial Key Laboratory of Clinical Research on Traditional Chinese Medicine Syndrome, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanmei","family":"Deng","sequence":"additional","affiliation":[{"name":"Department of Hepatology, Guangdong Provincial Key Laboratory of Clinical Research on Traditional Chinese Medicine Syndrome, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junmin","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of Hepatology, Guangdong Provincial Key Laboratory of Clinical Research on Traditional Chinese Medicine Syndrome, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,29]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"209","DOI":"10.3322\/caac.21660","article-title":"Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"71","author":"Sung","year":"2021","journal-title":"CA Cancer J Clin"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"681","DOI":"10.1016\/j.jhep.2021.11.018","article-title":"BCLC strategy for prognosis prediction and treatment recommendation: the 2022 update","volume":"76","author":"Reig","year":"2022","journal-title":"J Hepatol"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"e00506","DOI":"10.14309\/ctg.0000000000000506","article-title":"Decision-making scoring system for the repetition of 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