114 | Chapter 4 Discussion Our study found that almost all patients with locally advanced laryngeal cancer experienced clinically significant decisional conflict (CSDC, 97.8%). The median DCS score (73.44) was alarmingly high during the decision-making process (T1) and remained high for most patients over time (T2). The DCS subscale analyses showed similar patterns with no significant changes over time. To our knowledge, only one study reported on DC in laryngeal cancer patients and showed a mean DCS score of 25.6 (range 0-78)31, which is much lower than our findings. However, they included all tumor stages of which only nineteen patients (38%) had locally advanced laryngeal cancer. Recent research showed that almost half (48%) of the headand-neck cancer patients faced CSDC32. A mix of head-and-neck cancer subsites and stages was included in that study, making it hard to compare with our data. They did not find significant predictors for CSDC in their univariate analysis but did not gather information regarding SDM. In contrast, our study included a homogenous group of patients, which may provide a more realistic image of the DC in patients with locally advanced laryngeal cancer who consequently face more complicated treatment decisions. When comparing the DC scores and incidence of CSDC in other diseases, it can be concluded that both are remarkably high in our patient group. In comparison, women with breast cancer considering breast reconstruction experience a mean DCS score of 46.18 (SD 15.22) with 68% experiencing CSDC33 and in men with localized prostate cancer a mean DCS-score of 37.3 (SD 18.1) was found34. Reasons for the high DCS scores in our group could be due to the high impact of all treatment options on quality of life, functional and aesthetic outcomes, and the potential risks. The information is complex and technical, and the tradeoffs between survival and larynx preservation are hard to interpret without sufficient knowledge. Risk factors for developing head-and-neck cancer are low social economic status (SES), low health literacy35. We did not investigate this in our sample, but this could contribute to the level of DC36. The decision on which treatment to choose is tough, even for the treating physician, and it requires careful consideration of many factors and weighing potential outcomes based on risk assessments. The consequences of these high DC scores are not investigated in this study. But other research has shown that scores >37.5 are associated with fretting regularly, postponed decision-making and nervousness19,27. These could lead to a decline in QoL and decision regret. What we do know about our patient group is that they are at high risk
RkJQdWJsaXNoZXIy MTk4NDMw