262 | Chapter 12 There was a positive association between the duration of consultations and observed SDM scores. Our findings suggest that more attention should be paid to patients’ goals, values, and preferences during consultations to improve SDM quality. Chapter 4 examined knowledge levels, decisional conflict and perceived SDM in patients with advanced laryngeal cancer who could choose between larynxpreserving treatment or a total laryngectomy, both options having significant impact on their quality of life and differ in survival rates. The study revealed that nearly all participants (98%) experienced significant decisional conflict after counseling. Additionally, patients’ knowledge of treatment options was low, with an average correct response rate of 47% on knowledge questions. This lack of understanding, especially regarding laryngectomy, underscores the need for improved patient education, despite reasonably high levels of perceived SDM reported by both patients and physicians. Chapter 5 follows up on Chapter 4 by investigating the impact of a newly developed PDA on these patients. The group using the PDA showed less decisional conflict and greater knowledge compared to the standard procedure group (Chapter 4). They also experienced higher levels of perceived SDM. The results indicate that using a PDA contributes to more effective decision-making for patients with advanced laryngeal cancer by reducing decisional conflict and enhancing knowledge and perceived SDM. Chapter 6 describes the development of a PDA for patients with oropharyngeal cancer eligible for curative surgery or radiation therapy. Using international standards and methods such as in-depth interviews and think-aloud sessions, this decision aid was designed to clearly explain treatment options. It was extensively evaluated and adjusted with input from both survivors and medical specialists, resulting in a user-friendly and informative tool. The decision aid highlights differences in short- and long-term effects between surgery and radiation and is appreciated for its clarity and usefulness in the decision-making process. Part 2: Rehabilitation after Total Laryngectomy In Chapter 7, we investigated whether the prophylactic replacement of VPs could prevent leaks in patients after TL. These leaks negatively impact patients’ quality of life and lead to unplanned hospital visits. We analyzed data from patients treated between 2000 and 2012 at the Netherlands Cancer Institute. Our results showed significant variability in VP lifespans both between and within patients, making prophylactic replacement impractical. Predicting VP lifespan and setting
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