Modeling Stakeholder Preferences for XR-Supported Pediatric Surgical Care: A Fuzzy AHP-Based Decision-Support Framework

Pediatric surgical care requires clinicians and parents/caregivers to jointly navigate complex, multidimensional decisions. Extended reality (XR) technologies—including virtual reality (VR), augmented reality (AR), and mixed reality (MR)—operationalize the healthcare metaverse concept and may enhance communication, emotional preparedness, and shared understanding prior to pediatric surgery. However, no stakeholder-centered decision-support framework has yet been reported for systematically evaluating and prioritizing criteria relevant to XR-supported pediatric surgical care. This study proposes a multi-criteria decision-making (MCDM) framework to identify and prioritize criteria for XR-supported pediatric inguinal hernia surgery. A hierarchical model comprising four main criteria and twelve sub-criteria was developed. The main criteria were Safety and Treatment Outcome (C1), Understanding and Communication (C2), Emotional and Family Experience (C3), and Practical Use and Technology (C4). Preferences were elicited from 10 pediatric surgeons and 15 parents/caregivers through structured pairwise-comparison questionnaires and analyzed using Buckley’s fuzzy AHP method with geometric-mean group aggregation. Three stakeholder-weighting scenarios were examined: balanced (50–50), clinician-priority (70–30), and family-centered (30–70). Safety and Treatment Outcome (C1) remained the highest-ranked criterion across all scenarios. Emotional and Family Experience (C3) became increasingly important as caregiver influence increased, reaching a weight of 0.26 under the family-centered scenario. Under the clinician-priority scenario, C1 received its highest weight of 0.54. Understanding and Communication (C2) also gained importance as caregiver influence increased, whereas Practical Use and Technology (C4) ranked lowest across all scenarios (0.10–0.11). All consistency ratios were well below the accepted threshold of 0.10. The proposed fuzzy AHP framework provides a structured and transparent approach to eliciting and integrating multistakeholder preferences as a decision-support precursor to shared decision-making in XR-supported pediatric surgical contexts. The findings reveal systematic differences between clinician and caregiver priorities and provide guidance for designing XR-based decision-support tools in pediatric surgery. This study evaluates stakeholder preferences regarding decision criteria; it does not assess the clinical use or effectiveness of an implemented XR application.