Clinical Scorecard: Patient Regret Regarding Treatment Choices in Primary and Secondary Brain Tumors: A Bicentric Cross-Sectional Exploratory Study

At a Glance

Key Highlights

• Decision regret (DR) is defined as dissatisfaction or distress with past healthcare decisions and has not been previously analyzed in brain tumor patients.
• DR may negatively impact emotional, social, and physical well-being and is associated with anxiety, stress, and lower health-related quality of life (HRQoL).
• Shared decision making (SDM) is critical to reduce DR by ensuring adequate patient information and alignment of patient preferences with treatment decisions.

Guideline-Based Recommendations

Diagnosis

• Assess decision regret using the validated 5-item Decision Regret Scale (DRS) separately for radiotherapy, systemic treatment, and surgery decisions.
• Evaluate health-related quality of life with EORTC QLQ-C30 and brain tumor-specific symptom burden with EORTC BN20.
• Screen for psychological distress using the NCCN distress thermometer, anxiety with GAD-7, and depression with PHQ-9.

Management

• Implement shared decision making (SDM) to align treatment decisions with patient preferences and reduce decision regret.
• Provide adequate information and support to patients before treatment initiation to minimize future regret and psychological distress.
• Consider the impact of treatment side effects and disease progression on patient well-being when discussing treatment options.

Monitoring & Follow-up

• Regularly monitor patient-reported decision regret post-treatment to identify those needing additional psychological or social support.
• Assess ongoing HRQoL, distress, anxiety, and depression to guide supportive care interventions.
• Use follow-up assessments to evaluate the effectiveness of SDM and patient satisfaction with care.

Risks

• High decision regret may lead to increased anxiety, stress, and reduced quality of life.
• Inadequate involvement in decision-making or insufficient information provision can increase risk of decision regret.
• Intensive treatments with significant side effects, especially in palliative settings, may predispose patients to regret.

Patient & Prescribing Data

Patients with primary brain tumors and brain metastases undergoing radiotherapy, systemic therapy, and/or surgery

Decision regret was assessed separately for each treatment modality; overall regret scores were calculated when multiple treatments were involved, highlighting the importance of individualized patient support.

Clinical Best Practices

• Use validated tools (DRS, EORTC QLQ-C30, BN20, NCCN distress thermometer, GAD-7, PHQ-9) for comprehensive assessment of patient well-being and decision regret.
• Engage patients in shared decision making to ensure treatment choices reflect their preferences and values.
• Provide clear, timely, and comprehensive information about treatment options, risks, and expected outcomes.
• Identify patients with high decision regret early to offer targeted psychosocial interventions.
• Consider the cumulative burden of multimodal treatments on patient quality of life when planning therapy.

References

• WHO Classification of Tumors of the Central Nervous System, 5th edition
• Decision Regret Scale validation study
• EORTC QLQ-C30 questionnaire
• EORTC BN20 brain tumor module
• NCCN Distress Thermometer
• GAD-7 Anxiety Scale
• PHQ-9 Depression Scale