Decisional Conflict and Regret | 49 2 Shame and Stigma Scale (SSS) Three out of four studies using the SSS included a mix of tumors and stages47–49, one only included nasopharyngeal tumors50. The study populations varied from 42-219 participants. All authors provided additional data, with prevalence of DR ranging from 72.1% to 85.8%. Decision Regret Scale (DRS) The studies using the DRS (n=11) were published between 2010 and 202229–33,51–56. Most studies included all tumor stages, and a mix of treatments. Four studies used prevalence to report DR33,51–53, of which one studied the level of DR after choosing deescalation treatment instead of regular treatment and found that nobody experienced regret33. Upon our request, five30,52,54–56 of the eight30–33,52,54–56 authors approached provided additional data for calculating prevalence estimates. With exclusion of the de-escalation treatment study33, the prevalence of DR varied from 14.2% to 85.5% (median 61.4%). The lowest prevalence was reported in a study investigating DR in patients that had received radiation for nasopharyngeal tumors52. Meta-analysis of the prevalence of Decisional Regret Data of sixteen studies were included in the meta-analyses, with in total 2727 participants of whom 1452 had DR. We performed separate meta-analyses for the data of study-specific questionnaires (n=5) and data of validated questionnaires (N=11), the latter including a subgroup analysis for the SSS and DRS results. The meta-analysis of validated questionnaires showed significant high heterogeneity (I2 = 94%) between studies (see figure 2A). The overall pooled DR prevalence was 71% (95% CI 58% – 82%). One outlier (Ho et al.52), concerned DR in nasopharyngeal carcinoma patients receiving radiation therapy and reported a markedly lower prevalence (14%). Sensitivity analysis excluding this study reduced DRS-subgroup heterogeneity by only 5% (to 89%) and did not have a meaningful impact on the overall results. Meta-analysis of the study specific questionnaire group (N=5) showed a significant and high heterogeneity (I2 = 92%, see figure 2B), with pooled DR prevalence of 11% (95% CI 5% – 22%).
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