<p>Total neoadjuvant therapy (TNT) involves incorporating systemic chemotherapy in the interval between radiation and TME surgery for locally advanced rectal cancers (LARC). Patients who achieve complete clinical response can be considered for organ preservation by opting for watch and wait strategy. The studies focusing on patient’s preferences for treatment are scarce. This is a cross-sectional study among patients with LARC and addresses their treatment preferences in correlation with psychological parameters. All LARC (mid or lower third) patients planned for multimodality treatment were included in the study. Patients were explained about standard treatment and non-operative management. They were then interviewed with questionnaires for the assessment of their preference. In our study, a total of 60 patients with LARC planned for neoadjuvant chemo radiation were included. Non-operative management (NOM) was preferred by about 35.0% of the subjects. NOM was preferred more by patients ≤ 65 years age group (66.7%), those with less education status (43%) (<i>p </i>= 0.024), and those from rural background (66.7%) (<i>p </i>= 0.011). Psychosocial factors like fear of progression (FOP) had statistically significant association (<i>p </i>= 0.001) with preference for NOM, while other factors like life orientation and locus of control failed to show significant association. Our study underlines the patient preferences and factors affecting the decision making and shows the importance of the concept of “shared decision-making” by discussing the treatment options, and its related side effects and outcomes to choose a treatment strategy.</p>