Decisional regret in oncology: a scoping review

Decisional regret (DR) is an important patient-reported outcome, reflecting patients' retrospective evaluation of healthcare decisions. In oncologic settings, treatment choices typically involve trade-offs between survival, toxicity and/or quality of life, which may influence DR after decisions are made. This scoping review aimed to map the existing literature on DR among adult patients with cancer and to characterise how DR has been measured, reported and associated with clinical and psychosocial factors across oncology contexts.

MEDLINE, EMBASE and Cochrane CENTRAL were searched from database inception to the search date. Studies involving adults with cancer that measured DR using a defined instrument were included. Data were extracted on study characteristics, cancer types, treatment context, measurement tools, timing of DR assessment and associated factors. Findings were synthesised descriptively and thematically.

Among 858 identified records, 104 studies were included in this review. The Decisional Regret Scale was the most frequently used instrument. Most studies assessed DR after treatment completion, commonly within 24 months following treatment decisions. DR levels were generally low to moderate. Higher DR was associated with treatment-related morbidity, psychological distress, inadequate information, limited involvement in decision-making and discordance between expectations and outcomes.

DR in oncology is influenced by clinical outcomes and quality of the decision-making process. Greater emphasis on shared decision-making, communication and expectation management may help reduce DR and improve patient-centred cancer care.Keywords: Decisional regret, cancer, decision regret scale, treatment decision making, psychosocial factors.