Decisional Conflict and Regret | 67 2 Appendix B: Additional information on the measurement instruments Decisional Conflict Scale (DCS)11 This scale consists of 16 statements with 5 response categories (strongly agree to strongly disagree). Although there is no official cut-off point, the most commonly used cut-off considered to indicate DC is a score greater than or equal to 25 points71. SURE questionnaire45 This questionnaire contains four items that can be scored with yes (1 point) or no (0 points). Scores below 4 points are considered to indicate clinically significant decisional conflict72. Shame and Stigma Scale (SSS) 47,73 The SSS was developed to measure the impact of treatment for head-and-neck cancer on the Quality of Life of patients through four specific domains: shame with appearance (8 items), sense of stigma (6 items), regrets (3 items) and social concerns (3 items). The total and subscales scores are calculated by summing the responses to the relevant items and then multiplying the sum by a scaling constant [100 / (4 * number of items on scale). Scores range from 0 (not at all) to 100 (a lot). All domains can be used separately, so we used the scores of the regret domain as score for decision regret. Decision Regret Scale (DRS)74 The DRS was developed in 1996 and has been validated for multiple fields and widely used for many years. The DRS consists of five statements with five answer options ranging from strongly agree to strongly disagree. Scores are converted to a 0-100 scale, where a score of 0 means no regret; a score of 100 means high regret75.
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