42 | Chapter 2 Introduction Head-and-neck cancer (HNC) often requires complex treatment. The head-and-neck area houses numerous vital anatomical structures responsible for essential functions like speaking, breathing, eating, and swallowing. During HNC treatment, these structures may be damaged, leading to functional impairments. In addition, HNC treatment can lead to disfigurement. These side-effects lead to a deterioration of Quality of Life (QoL)1. HNC is often curable when treated in an early stage, whereas advanced stages of disease have a higher mortality rate and also significantly higher morbidity2,3. HNC is a rare and aggressive disease in which numerous difficult decisions must be made based on relatively limited information and time4. Also, there is a trade-off between survival and QoL5. When making a treatment choice, patients can experience decisional conflict (DC). DC is a state of uncertainty that arises when a person faces a challenging decision with competing options, and feels unsure about which choice to make6,7. DC has many negative consequences, such as delay in decision-making, making treatment choices that are not in line with patients’ preferences, and decisional regret11,12. Decisional regret (DR) is a negative feeling associated with grief, disappointment, or distress following a decision regarding healthcare. DR is a complex construct that is associated with multiple variables such as socio-demographics, disease, side-effects, chosen treatment, but primarily with DC and received information13–15. DR may have serious consequences such as decline in QoL, incomplete recovery from treatment, and depression13,16. Given the complex nature of the decisions to be made in HNC, and the many risk factors predisposing for DC and DR that are often present in this patient population, such as lower health literacy, frailty, and psychosocial problems17,18, DC is looming and the potential for developing DR is high. This systematic review aims to provide an overview of the current literature on DC and DR in HNC patients, and to obtain reliable estimates of prevalence and degree. Such insights are important for guiding advice on clinical practice and future research.
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