Decisional Conflict in Advanced Larynx Cancer | 107 4 Figure 1. Workflow of the study Measures Sociodemographic and clinical characteristics We collected data on the patients’ age, sex, educational level, marital status, employment status, family history of head-and-neck cancer, comorbidities, diagnosis, tumor stage, tumor subsite, initial treatment, and adjuvant treatment. Decisional Conflict Scale Decisional conflict (DC) was measured with the validated Decisional Conflict Scale (DCS)16,24. This 16-item scale has five subscales: feeling informed, decisional uncertainty, clear values, support, and quality of decisions. Each item is scored on a five-point Likert scale from 0 (strongly agree) to 4 (strongly disagree). Total scores and subscale scores are calculated. Scores can range from 0 (no DC) to 100 (extremely high DC). DCS < 25 are associated with implementing decisions, while scores >37.5 are related to decision delay and uncertainty about the choice16. A score >25 was used as cutoff for Clinically Significant DC (CSDC). This cutoff point is most used to distinguish between normal scores and harmful levels of decisional conflict25–27. Shared Decision-Making The Shared Decision Making (SDM) process was assessed with the Dutch versions of the SDM-Q9 instrument (for patients) and SDM-Q-Doc (for physicians), which have both been validated for this purpose22,28,29. The instruments provide nine statements, rated on a 6-point scale from 0 (completely disagree) to 5 (completely agree). Scores can range from 0 (no perceived SDM) to 100 (highest level of perceived SDM). There is no cutoff point for this questionnaire.
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