Individualized Prognostic Counseling for Decision-Making in Head and Neck Cancer: A Nonrandomized Clinical Trial

Area of Science:

• Oncology
• Decision Sciences
• Health Services Research

Background:

• Managing head and neck squamous cell carcinoma (HNSCC) requires balancing prognosis and quality of life.
• The impact of individualized prognostic counseling on patient decision-making in HNSCC is not well understood.

Purpose of the Study:

• To evaluate the association between individualized prognostic counseling and the decision-making process in primary HNSCC patients.
• To assess the effect of an online prognostic model on decisional conflict and patient roles in treatment choice.

Main Methods:

• Prospective nonrandomized clinical trial with sequential cohorts at an academic tertiary referral center.
• Cohort 1 received standard care; Cohort 2 received standard care plus individualized prognostic counseling via an online model.
• Decisional Conflict Scale, Control Preferences Scale, decisional regret, treatment choice, and quality of life were primary and secondary outcomes.

Main Results:

• Individualized prognostic counseling was associated with lower decisional conflict in both small laryngeal squamous cell carcinoma (SLSCC) and other HNSCC groups.
• Decisional regret decreased at 3-6 months post-counseling, with small to moderate improvements observed.
• An association was found between individualized counseling and more active/shared decision-making roles in the other HNSCC group; no significant quality-of-life differences were noted.

Conclusions:

• Individualized prognostic counseling, particularly using an online model, improves decisional conflict and regret in HNSCC patients.
• This approach promotes more active and shared decision-making roles, enhancing patient engagement.
• Integrating individualized prognostic information into routine care may optimize treatment choices and reduce patient uncertainty.