Introduction | 29 1 Despite its proven benefits, maximal CPET has not found widespread use in laryngectomy rehabilitation. This may be attributed to the intensive focus on other aspects of rehabilitation, such as vocal rehabilitation, which often take precedence due to their immediate impact on quality of life. However, with advancements in medical care, laryngectomy patients are now surviving longer, leading to an increased need for comprehensive rehabilitation strategies. Incorporating maximal CPET into laryngectomy rehabilitation could provide crucial information about patients’ aerobic capacity and exercise tolerance, aiding in the optimization of their overall functional capacity and quality of life. Nevertheless, integrating this presents unique challenges. One significant obstacle is the use of a face mask during the test, which is essential for accurate measurement of respiratory parameters but is not useful for laryngectomy patients since their airway ends in their neck after surgery. This difficulty in using traditional CPET equipment highlights the need for innovative approaches and adaptations to make maximal CPET accessible and beneficial for laryngectomy patients. Overcoming these challenges could unlock the potential of maximal CPET as a valuable tool in optimizing the rehabilitation outcomes and long-term well-being of laryngectomy patients. Overview and aims of this thesis This thesis is divided into two parts, each dedicated to distinct yet interconnected aspects of head-and-neck cancer (HNC) care. The first part focuses on shared decisionmaking dynamics, specifically examining advanced laryngeal cancer and operable oropharyngeal carcinoma. It aims to provide insights into the prevalence of decisional conflict and decision regret among head-and-neck oncology patients, exploring whether enhanced counseling can reduce these issues while also augmenting knowledge. Additionally, this part investigates the development and impact of patient decision aids (PDAs) in facilitating informed decision-making processes. The second part centers on rehabilitation strategies tailored to patients undergoing Total Laryngectomy (TL). The aim of this part is to contribute to the advancement of knowledge regarding rehabilitation techniques and assistive devices, with the ultimate goal of improving outcomes for TL patients. Part 1: Shared Decision Making in Head and Neck Oncology Chapter 2 presents a systematic review and meta-analysis, delving into the current literature on the prevalence of decisional conflict and decision regret among individuals diagnosed with head-and-neck cancer. Through an exhaustive examination of existing research, we aimed to provide a comprehensive understanding of the challenges faced by patients in making treatment decisions. In Chapter 3, we shifted our focus inward
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