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Meta-Analysis
. 2024 May 1;150(5):393-404.
doi: 10.1001/jamaoto.2024.0214.

Decisional Conflict and Decision Regret in Head and Neck Oncology: A Systematic Review and Meta-Analysis

Anne Nadine Heirman  1 , Coralie Romé Arends  1 , Dominique Valérie Clarence de Jel  1 , Richard Dirven  1 , Lisette van der Molen  1 , Gyorgy Bela Halmos  2 , Michiel Wilhelmus Maria van den Brekel  1   3 , Martijn Matthias Stuiver  1   4   5
Affiliations
Meta-Analysis

Decisional Conflict and Decision Regret in Head and Neck Oncology: A Systematic Review and Meta-Analysis

Anne Nadine Heirman et al. JAMA Otolaryngol Head Neck Surg. .

Abstract

Importance: Head and neck cancer (HNC) often requires treatment with a major impact on quality of life. Treatment decision-making is often challenging, as it involves balancing survival against the preservation of quality of life and choosing among treatments with comparable outcomes but variation in morbidity and adverse events; consequently, the potential for decisional conflict (DC) and decision regret (DR) is high.

Objectives: To summarize the literature on DC and DR in HNC, to give an overview of its prevalence and extent, and to advise on clinical practice and future research.

Data sources: Embase, Web of Science, MEDLINE, and PsycINFO were searched up to February 24, 2023, including all years of publication.

Study selection: Eligible studies addressed DC and/or DR as primary or secondary outcomes with any instrument in HNC, except cutaneous tumors. Two mutually blinded researchers conducted screening and inclusion with support of an artificial intelligence assistant and conducted risk of bias (ROB) assessment.

Data extraction and synthesis: The Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines were followed for data extraction. ROB assessments were done using Critical Appraisal Skills Programme (qualitative) and CLARITY (quantitative). Meta-analysis with a random-effects model was used to obtain pooled prevalence estimates for DC and DR when at least 4 sufficiently clinically homogeneous studies were available.

Main outcomes and measures: Prevalence of DC (qualitative, Decisional Conflict Scale, SURE questionnaire) and DR (qualitative, study-specific questionnaires, Decision Regret Scale, Shame and Stigma Scale).

Results: Overall, 28 studies were included, with 16 included in meta-analyses for DR prevalence. The pooled prevalence of clinically relevant DR above the cutoff score for validated questionnaires (11 studies; 2053 participants) was 71% (95% CI, 58%-82%; I2 = 94%), while for study-specific questionnaires (5 studies; 674 participants) it was 11% (95% CI, 5%-22%; I2 = 92%). Only 4 studies investigated DC, showing a prevalence of 22.6% to 47.5% above cutoff values. Derived overarching themes found in qualitative studies were preparation, shared decision-making roles, information, time pressure, stress of diagnosis, and consequences.

Conclusions and relevance: Although limited data on DC and DR were available, the studies performed indicated that DC and DR are highly prevalent issues in HNC. Results suggest that study-specific questionnaires underestimated DR. The findings underscore the rationale to improve counseling and shared decision-making for this patient population.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr van der Molen reported receiving grants to the institution from Atos Medical AB during the conduct of the study; participating in the Dutch guidelines working group on head and neck rehabilitation and aftercare; and serving as a guest lecturer of the Masterprogram Physical Therapy and Lymphedema as well as the Masterprogram oral facial therapist outside the submitted work. Drs Dirven and van den Brekel reported receiving grants to the institution from Atos Medical AB. No other disclosures were reported.

Figures

Figure.
Figure.. Forest Plot of Pooled Prevalence of Decisional Regret (DR)
See this image and copyright information in PMC

References

    1. Rogers SN, Ahad SA, Murphy AP. A structured review and theme analysis of papers published on ‘quality of life’ in head and neck cancer: 2000-2005. Oral Oncol. 2007;43(9):843-868. doi:10.1016/j.oraloncology.2007.02.006 - DOI - PubMed
    1. Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer statistics, 2022. CA Cancer J Clin. 2022;72(1):7-33. doi:10.3322/caac.21708 - DOI - PubMed
    1. Gatta G, Botta L, Sánchez MJ, Anderson LA, Pierannunzio D, Licitra L; EUROCARE Working Group . Prognoses and improvement for head and neck cancers diagnosed in Europe in early 2000s: the EUROCARE-5 population-based study. Eur J Cancer. 2015;51(15):2130-2143. doi:10.1016/j.ejca.2015.07.043 - DOI - PubMed
    1. Bhat GR, Hyole RG, Li J. Head and neck cancer: current challenges and future perspectives. Adv Cancer Res. 2021;152:67-102. doi:10.1016/bs.acr.2021.05.002 - DOI - PubMed
    1. McNeil BJ, Weichselbaum R, Pauker SG. Speech and survival: tradeoffs between quality and quantity of life in laryngeal cancer. N Engl J Med. 1981;305(17):982-987. doi:10.1056/NEJM198110223051704 - DOI - PubMed

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