244 | Chapter 11 Summary of the findings Part 1: Shared Decision-Making in Head and Neck Oncology In Chapter 2 we saw that, although limited data on Decisional Conflict (DC) and Decision Regret (DR) were available, the performed studies 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 decisionmaking for this specific patient population. Chapter 3 showed that the observed level of shared-decision making (SDM) in our tertiary oncologic center was scored as moderate, yet both patients and surgeons perceived SDM more positively than observed in the scoring. Surgeons particularly do well discussing treatment options and forming partnerships, but surgeons often wrongly assume patients’ preference for involvement. In Chapter 4, we found that almost all patients with advanced laryngeal carcinoma experience high levels of DC, and that the level of knowledge regarding treatment options was low, indicating for better patient counseling. In Chapter 5 showed that the patient decision aid for patients with advanced laryngeal cancer effectively reduced decisional conflict, enhanced patients’ knowledge and improved perceived SDM. The last chapter of this section, Chapter 6, displays the development of a PDA for early stage oropharyngeal cancer patients considering surgery or radiotherapy, as treatment options. The decision aid emphasizes the disparities in short- and long-term side effects between the two treatments. Patients and physicians found the decision aid to be understandable, user-friendly, and helpful for future patients. Part 2: Rehabilitation after TL In Chapter 7, we showed that prophylactic replacement of voice prostheses after TL is not feasible due to high inter-and intrapatient variation in device lifetime. We tested a new voice prosthesis (PVHP) in laryngectomized patients in Chapter 8, and found that acceptance of the PVHP is largely dependent on device lifetime, decreasing from 87% to 40% after leakage or replacement. Voice quality remains consistent across different VPs. In Chapter 9, we found that Maximal Cardiopulmonary Exercise testing in laryngectomized patients is feasible, however the protocol does not seem appropriate to reach this group’s maximal exercise capacity. Lowering HME resistance does not increase exercise capacity in this cohort. Lastly, in Chapter 10, we describe one of our laryngectomized patient’s ability to sing with a hands-free voice prosthesis, allowing him to simultaneously play guitar.
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