Risk attitudes and value of hope: survey results from Japanese hematologists and oncologists treating patients with diffuse large B-cell lymphoma

The "value of hope" refers to treatments that offer a small probability of cure without necessarily improving average survival. While this concept has gained attention in the academic literature, little is known about how physicians perceive and integrate it into clinical decision-making. This study explored the treatment preferences of Japanese hematologists and oncologists in managing diffuse large B-cell lymphoma (DLBCL), with a focus on factors influencing the choice between riskier and more predictable options. An online survey was distributed to 231 physicians, using hypothetical patient vignettes that varied by age, ECOG performance status, and likelihood of long-term remission. For each scenario, respondents chose between a treatment with a certain but limited survival outcome and a riskier "hopeful" treatment offering the same expected survival but a chance of longer remission. Physician demographics, experience, and institutional factors were also collected. Across scenarios, 29-40% of physicians selected the hopeful treatment. The likelihood of choosing this option decreased when certain survival was longer (6 vs. 3 months). Younger physicians and those working in larger or university hospitals were significantly more likely to favor hopeful treatments, as were those in institutions meeting CAR-T use guideline criteria. These findings suggest that physicians, like patients, may place value on treatments offering even small chances of extended survival.