Decisional Conflict in Advanced Larynx Cancer | 115 4 for depression and anxiety after treatment, which one could hypothesize might be partially caused by their high level of decisional conflict and low knowledge levels37,38. More research is needed to investigate the consequences of CSDC for this patient group. A weak but significant positive correlation was found between the perceived level of SDM by physicians and patients, and DC, whereby experiencing more SDM resulted in a higher DC score. This finding is in contrast with other research, where experiencing more SDM has been correlated with experiencing less DC39–41. These relationships could be population-specific, and the disparity may be due to the very complex information HNC patients receive and their relatively low educational level, making the shared information hard to process. If this is indeed the case, this suggests that current shared decision-making is insufficiently tailored to the capabilities of this patient group. Furthermore, it is essential to note that SDM questionnaires are inherently subjective and might not accurately reflect the extent to which there was SDM, thus introducing uncertainty regarding whether SDM was effectively applied42,43. One should keep in mind that this is a relatively small sample for correlation analysis, with a high number of CSDC and high scores on the SDM questionnaires, which limits the possibility of finding precise correlations. Hence, these findings should be cautiously interpreted. A French study investigating the personal treatment preferences of otolaryngologists/ head-and-neck surgeons44 and radiation-oncologists45 for advanced laryngeal cancer has demonstrated the challenge of decision-making among physicians. Their findings revealed that physicians’ personal choices were almost evenly split between TL and larynx preservation. The proportion of potential cure they were willing to give up to preserve their larynx was relatively low (median 15%, range 5-100%). A small minority (4.2%) expressed a willingness to give up any chance of cure to avoid TL entirely. Interestingly, they found that specialists regularly attending the head-and-neck oncology tumor board, and specialists with more years of practice were more likely to consider a higher survival tradeoff to preserve their larynx. These results underscore that even with substantial knowledge and insights, the complexity of treatment options continues to pose significant challenges to the decision-making process. In a study examining the treatment preferences of 309 individuals without cancer who were presented with a scenario of advanced laryngeal cancer, it was found that 40 out of 309 (12.9%) were unable to make a treatment choice2. Notably, almost 25% of the patients were unwilling to make any compromise on achieving a cure to preserve their larynx. The extent of cure that patients were willing to sacrifice varied widely, with an average of 33% and a range of 5-100%. This highlights the critical importance of eliciting and incorporating patients’ values and preferences in decision-making.
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