title: Patient Reflections on Decision Making for Laryngeal Cancer Treatment.
abstract: Objective To describe the reflections of patients treated for laryngeal cancer with regard to treatment-related decision making. Study Design Cross-sectional survey-based pilot study. Setting Single-institution tertiary care cancer center. Subjects/Methods Adults with laryngeal carcinoma were eligible to participate (N = 57; 46% treated surgically, 54% nonsurgically). Validated surveys measuring decisional conflict and regret explored patients' reflections on their preferences and priorities regarding treatment-related decision making for laryngeal cancer and how patient-reported functional outcomes, professional referral patterns, and desired provider input influenced these reflections. Results When considering the level of involvement of surgeons, radiation oncologists, and medical oncologists in their care, patients were more likely to believe that the specialist whom they saw first was the most important factor in deciding how to treat their cancer (Fisher's exact, ~χ2= 16.2, df = 6, P = .02). Patients who were treated for laryngeal cancer who reported worse voice-related quality of life recalled more decisional conflict ( P = .01) and experienced more decisional regret ( P < .001). Of the patients for whom speech was a top priority prior to treatment, better voice-related quality of life overall scores were correlated with less decision regret about treatment decisions ( P < .02). Of the patients for whom eating and drinking were top priorities prior to treatment, better MD Anderson Dysphagia Inventory global scores were correlated with less decision regret about treatment decisions ( P < .002). Conclusion Patient priorities and attitudes, coupled with functional outcomes and professional referral patterns, influence how patients reflect on their choices regarding management of laryngeal cancer. Better understanding of these variables may assist in ensuring that patients' voices are integrated into individualized laryngeal cancer treatment planning.
authors.affiliation: 1 Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.|2 Division of Medical Ethics, Weill Cornell Medical College, New York, New York, USA.|3 Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Shuman
authors.affiliation: 3 Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Knoll
authors.initials: K
authors.lastname: Larkin
authors.affiliation: 1 Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
authors.forename: Dorothy
authors.initials: D
authors.lastname: Thomas
authors.affiliation: 1 Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
authors.forename: Frank L
authors.initials: FL
authors.lastname: Palmer
authors.affiliation: 2 Division of Medical Ethics, Weill Cornell Medical College, New York, New York, USA.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Fins
authors.affiliation: 4 Head and Neck Oncology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors.forename: Shrujal S
authors.initials: SS
authors.lastname: Baxi
authors.affiliation: 5 Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
authors.forename: Nancy
authors.initials: N
authors.lastname: Lee
authors.affiliation: 1 Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
authors.forename: Jatin P
authors.initials: JP
authors.lastname: Shah
authors.affiliation: 3 Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan, USA.|6 Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.|7 VA Ann Arbor Center for Clinical Research Management, Washington, DC, USA.
authors.forename: Angela
authors.initials: A
authors.lastname: Fagerlin
authors.affiliation: 1 Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
authors.forename: Snehal G
authors.initials: SG
authors.lastname: Patel
mesh_terms: D003430:Cross-Sectional Studies; D003657:Decision Making; D005260:Female; D006801:Humans; D007822:Laryngeal Neoplasms / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010358:Patient Participation; D010865:Pilot Projects; D011795:Surveys and Questionnaires
keywords: larynx cancer; patient-reported outcomes; quality of life; shared decision making