Decisional Conflict in Palliative Head and Neck Cancer Patients

OBJECTIVE: Head and neck cancer (HNC) patients may be subject to decisional conflict (DC). However, research on DC in the palliative phase remains limited. The primary objective of this study was to assess and describe DC among patients with HNC in the palliative phase and explore the association between clinically significant DC and quality of life (QoL). STUDY DESIGN: Prospective cohort study. SETTING: Tertiary cancer center. METHODS: Patients with HNC entering the palliative phase between September 2022 and March 2024 were eligible. Patients were assessed in 2 cohorts: incurable HNC and refraining from curative treatment. DC was measured using the Decisional Conflict Scale (DCS). Other measures included patient, tumor, and palliative characteristics, and the EORTC QLQ-C15-PAL for QoL. RESULTS: Of 104 included patients, 72 patients had incurable HNC and 32 refrained from curative treatment. Clinically significant DC (score ≥25) was observed in 47 incurable HNC patients (65.3%) and 14 patients who refrained from curative treatment (43.8%), which was a significant difference. Tumor stage I/II was significantly predictive of less DC in patients who refrained from curative treatment. Three QoL domains showed large differences for incurable HNC patients when differentiating for clinically significant DC, and 6 for those who refrained from treatment. CONCLUSION: This study provides valuable insights into DC among palliative HNC patients. Clinically significant DC was more common in patients with incurable HNC than those who refrained from curative treatment. These findings highlight key differences between the cohorts, underscoring the need for tailored counselling to support patient-centered care.