64 | Chapter 2 Discussion With this systematic review, we aimed to provide a comprehensive overview of the quantitative and qualitative research on decisional conflict (DC) and decisional regret (DR) in Head-and-Neck cancer (HNC) patients. Overall, the results suggest that DC and DR are common in HNC patients and that the impact of DC and DR on these patients is substantial. Quality and completeness of the evidence A limited number of studies have been conducted over the years (1987-2022), with more studies in later years. However, research regarding this topic in HNC lags compared to more prevalent cancers. Overall, the available studies are of good methodological quality, with the most pertinent risk of bias resulting from low response rates and the use of non-validated questionnaires. Notably, the validated questionnaires used in the included studies have also not been evaluated specifically for use in a HNC population. Detailed reporting on the timing of the measurement of DC and DR was lacking. The inclusion criteria and measurement instruments differ across studies and results are heterogeneous. Risks of bias may, in part, result from DC and DR being secondary outcomes in many of the included studies. Main Results Decisional Conflict Between 1 in 4 and 1 in 2 HNC patients reported DC. Although patients with HNC generally have poorer prognosis, more psychosocial problems, and lower health literacy, these figures are comparable, or slightly lower, to the prevalence of DC in prostate cancer patients (23% to 61%15,57–61) and breast cancer patients (33-67%62–66), which have been studied more intensively. Further research is needed to obtain more reliable estimates of DC prevalence in HNC patients. Qualitative studies indicated that the stress of the diagnosis and lack of clear information regarding disease, treatments, and their impact, led to a high level of DC in most patients. Experienced lack of SDM made patients feel objectified. However, when patients did experience SDM, it was not always clear to them what their role was, which then led to additional uncertainty. Although we cannot know what level of SDM was applied, the results suggest a need for better implementation of SDM.
RkJQdWJsaXNoZXIy MTk4NDMw