Patient-reported factors that influence the vestibular schwannoma treatment decision: a qualitative study
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OTOLOGY
Patient‑reported factors that influence the vestibular schwannoma treatment decision: a qualitative study O. M. Neve1 · G. Soulier1 · M. Hendriksma1 · A. G. L. van der Mey1 · A. van Linge2 · P. P. G. van Benthem1 · E. F. Hensen1 · A. M. Stiggelbout3 Received: 28 July 2020 / Accepted: 23 September 2020 © The Author(s) 2020
Abstract Purpose In cases of small- to medium-sized vestibular schwannomas, three management strategies can be opted for: active surveillance, surgery or radiotherapy. In these cases, the patient’s preference is pivotal in decision-making. The aim of this study was to identify factors that influence a patient’s decision for a particular management strategy. Methods A qualitative inductive thematic analysis was performed based on semi-structured interviews. Eighteen patients with small- to medium-sized vestibular schwannomas were interviewed. All patients were diagnosed or treated at one of the two participating university medical centers in the Netherlands. Results Ten themes were identified that influenced the decision, classified as either medical or patient-related. The medical themes that emerged were: tumor characteristics, the physician’s recommendation, treatment outcomes and the perceived center’s experience. The patient-related themes were: personal characteristics, anxiety, experiences, cognitions, logistics and trust in the physician. Conclusion Knowledge of the factors that influence decision-making helps physicians to tailor their consultations to arrive at a true shared decision on vestibular schwannoma management. Keywords Vestibular schwannoma · Shared decision-making · Qualitative research · Patient-centered care
Introduction Vestibular schwannoma (VS) is a benign intracranial tumor, arising from schwann cells of the vestibular branch of the vestibulocochlear nerve. Current management options for VS generally consist of one of three modalities: microsurgery, radiotherapy or active surveillance (also known as wait-and-scan policy) [1]. Based on the available evidence, a clinical equipoise exists in the management of small- to * O. M. Neve [email protected] 1
Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands
2
Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
3
Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
medium-sized VS (up to 25 mm in extrameatal diameter). Active surveillance is a valid management option, especially in non-progressing tumors. However, hearing loss and vestibular problems may increase, even in otherwise stable tumors. In patients with (progressing) medium-sized tumors, both surgery and radiotherapy are viable options with equally high tumor control rates and generally good facial nerve outcome. Long-term hearing results are universally poor and vestibular function may be impacted, both after surg
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