PDA Impact in Advanced Larynx Cancer | 125 5 Introduction The medical world has seen a gradual shift from paternalistic decision-making toward shared decision-making (SDM). This paradigm shift underscores the growing recognition of the patient’s role in their healthcare journey, reflecting a broader trend across medical disciplines towards patient-centered care1,2. An effective way to improve the SDM process is the use of patient decision aids (PDA)3. PDAs are developed to enhance patients’ knowledge by providing evidence based information on treatment options, risks, benefits, expected morbidity and possible outcomes4. Over the years, PDAs have demonstrated their utility by providing patients with a better understanding of treatment options and helping them articulate their personal preferences3–5. When dealing with advanced laryngeal cancer, a range of therapies is applicable, ranging from total laryngectomy (TL), concurrent chemoradiotherapy (CRT), or primary TL with postoperative (C)RT. Patients and doctors are therefore often confronted with challenging decisions6–8. Each of these treatments has a major impact on prognosis and quality of life, potentially affecting voice, appearance, breathing, smelling, taste, swallowing and eating9–11. The decision to undergo a voice-box removing total laryngectomy is extremely difficult, largely due to the enduring and significant permanent side-effects associated with such a procedure. Whilst larynxpreserving strategies offer an alternative, their oncological and functional success is not guaranteed, and failure may necessitate a salvage TL, which carries higher risks of complications than an upfront TL7,12. Hence, it is important to adequately inform patients about their primary treatment choice, taking patients’ values and preferences into account2. The complexity of this choice may lead to decisional conflict (DC), a state of uncertainty about the choice to be made, aggravated by inadequate knowledge, unclear personal values and perceived lack of support13–15. DC can lead to a range of negative consequences, such as postponed decision-making, selection of treatments misaligned with patient preferences, decisional regret and depression16,17. Acknowledging these challenges, our research group developed a PDA specifically for patients with advanced laryngeal cancer18, which was evaluated in a multicenter study. In our previous study evaluating the usual care, we showed that patients had low levels of knowledge regarding the possible treatments and experienced high levels of decisional conflict (DC)19.
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