Patient Regret After Treatment Choices in Primary and Secondary Brain Tumors

Overview

This bicentric cross-sectional study assessed decision regret (DR) in patients with primary and secondary brain tumors following radiotherapy, systemic treatment, and surgery. The study explored associations between DR and health-related quality of life (HRQoL), psychological distress, and satisfaction with care.

Background

Primary brain tumors and brain metastases carry high morbidity and mortality, with limited curative options and median survival ranging from months to a few years depending on tumor type. Treatments such as chemoradiotherapy and whole brain radiotherapy can cause acute and late toxicities that negatively impact HRQoL. Decision regret, defined as distress or dissatisfaction with past healthcare decisions, may arise due to treatment side effects, disease progression, or inadequate involvement in decision-making. Understanding DR in brain tumor patients is crucial as it may affect emotional well-being and highlight gaps in shared decision making.

Data Highlights

The study included patients treated between 2010 and 2024 at two German university medical centers. Decision regret was measured separately for radiotherapy, systemic treatment, and surgery using the 5-item Decision Regret Scale (DRS). DR was classified as absent (0 points), mild (1–25 points), or strong (>25 points). Additional assessments included HRQoL via EORTC QLQ-C30 and BN20, distress via NCCN distress thermometer, anxiety via GAD-7, and depression via PHQ-9. Data collection occurred through mailed questionnaires and retrospective chart review.

Key Findings

• Decision regret was assessed separately for radiotherapy, systemic treatment, and surgery, capturing regret related to the decision itself regardless of treatment receipt.
• DR was categorized into absent, mild, and strong levels, allowing quantification of patient dissatisfaction with treatment decisions.
• Associations were explored between DR and HRQoL, psychological distress, anxiety, depression, and satisfaction with medical care.
• The study highlighted the potential impact of intensive treatments and palliative scenarios on patient regret, especially in high-grade glioma and brain metastases.
• Findings suggest that DR may identify patients needing additional support to improve shared decision making and reduce long-term distress.

Clinical Implications

Clinicians should be aware that patients with brain tumors may experience significant decision regret related to complex treatment choices, which can adversely affect psychological well-being and quality of life. Incorporating structured assessment of decision regret into follow-up may help identify patients requiring enhanced communication and psychosocial support. Emphasizing shared decision making and providing adequate information tailored to patient preferences could reduce regret and improve satisfaction with care.

Conclusion

This exploratory study underscores the importance of evaluating decision regret in brain tumor patients to better understand its prevalence and impact. Addressing decision regret through improved shared decision making may enhance patient-centered care and psychological outcomes in this vulnerable population.

References

1. Original Study Authors/2024 -- Patient Regret Regarding Treatment Choices in Primary and Secondary Brain Tumors