{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T16:11:02Z","timestamp":1772640662236,"version":"3.50.1"},"reference-count":61,"publisher":"American Medical Association (AMA)","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Otolaryngol Head Neck Surg"],"published-print":{"date-parts":[[2024,8,1]]},"abstract":"<jats:sec id=\"ab-ooi240035-4\"><jats:title>Importance<\/jats:title><jats:p>Clinicians should understand how patients who were treated with laryngeal cancer surgery think about this later on and what factors may be related with regretting surgery.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ooi240035-5\"><jats:title>Objective<\/jats:title><jats:p>To assess variables associated with a positive attitude toward laryngeal cancer surgery.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ooi240035-6\"><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>This combination of 2 cohorts, based on patient interviews and questionnaires, was studied in 16 hospitals in Germany. Participants scheduled for laryngeal cancer surgery were enrolled before surgery and followed up until 1 year after surgery. Data collection began on November 28, 2001, and ended on March 15, 2015. Statistical analysis was performed from August 21, 2023, to January 19, 2024.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ooi240035-7\"><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>The attitude toward surgery was measured with the Psychosocial Adjustment After Laryngectomy Questionnaire (scores range from 0 to 100, with high scores representing a positive attitude toward the surgery) at 1 year after surgery. In multivariate regression analysis, the following variables were investigated: type of surgery, number of surgeries to the larynx, receipt of radiotherapy and chemotherapy, quality of life, speech intelligibility (objectively measured), age, sex, educational level, employment status, having a partner or not, counseling by patient association, and shared decision-making.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ooi240035-8\"><jats:title>Results<\/jats:title><jats:p>Patients (n\u2009=\u2009780; mean [SD] age, 60.6 [10.4] years; 701 [90%] male) who had received counseling from the patient association reported a more positive attitude toward surgery (adjusted B\u2009=\u20098.8; 95% CI, 1.0-16.6). Among patients after total laryngectomy, those with a university degree had a less positive attitude toward their surgery (adjusted B\u2009=\u2009\u221250.8; 95% CI, \u221284.0 to \u201317.6); this result was not observed in patients after partial laryngectomy (adjusted B\u2009=\u2009\u20134.8; 95% CI, \u221215.1 to 5.4). Among patients after partial laryngectomy, the attitude toward surgery was most positive in those who had experienced shared decision-making (mean [SD] questionnaire score, 84 [20] in those without a wish and 83 [20] in those with a wish for shared decision-making). Those who had wished they could decide together with the physician but where this eventually was not experienced expressed the most regret toward surgery (mean [SD] score, 71\u2009[22]). There was no association between attitudes toward surgery and type of surgery (total vs partial laryngectomy) and all other variables tested.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ooi240035-9\"><jats:title>Conclusion and Relevance<\/jats:title><jats:p>In this cohort study, most patients with head and neck cancer reported a positive attitude toward surgery, suggesting low levels of decision regret. Counseling by members of patient associations as well as individualized shared decision-making prior to surgery may have a positive impact on decision regret and is advisable in daily practice.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamaoto.2024.1422","type":"journal-article","created":{"date-parts":[[2024,6,27]],"date-time":"2024-06-27T18:07:16Z","timestamp":1719511636000},"page":"666","source":"Crossref","is-referenced-by-count":8,"title":["Patients\u2019 Reflections on Treatment Decision After Surgery for Laryngeal Cancer"],"prefix":"10.1001","volume":"150","author":[{"given":"Susanne","family":"Singer","sequence":"first","affiliation":[{"name":"Division of Epidemiology and Health Services Research, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of the Johannes Gutenberg-University Mainz, Mainz, Germany"},{"name":"University Cancer Center Mainz, Mainz, 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Otorhinolaryngology and Head and Neck Surgery, Carl-Thiem-Klinikum Cottbus gGmbH, Cottbus, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Friedemann","family":"Pabst","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology and Head and Neck Surgery, Community Hospital Dresden, Dresden, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefan K.","family":"Plontke","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Center of Martin-Luther-University, Halle, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andreas","family":"Boehm","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, St Georg Hospital, Leipzig, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andreas","family":"Dietz","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Center of Leipzig University, Leipzig, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jens","family":"B\u00fcntzel","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, S\u00fcdharz-Krankenhaus Nordhausen, Nordhausen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hans-Joachim","family":"Vogel","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Sana-Klinikum Remscheid, Remscheid, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander","family":"Fabian","sequence":"additional","affiliation":[{"name":"Department of Radiotherapy, University Medical Center Schleswig-Holstein Kiel, Kiel, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Barbara","family":"Wollenberg","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology and Head and Neck Surgery, Technical University of Munich, Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katherine","family":"Taylor","sequence":"additional","affiliation":[{"name":"Division of Epidemiology and Health Services Research, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of the Johannes Gutenberg-University Mainz, Mainz, Germany"},{"name":"University Cancer Center Mainz, Mainz, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Haralampos","family":"Gouveris","sequence":"additional","affiliation":[{"name":"University Cancer Center Mainz, Mainz, Germany"},{"name":"Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Centre of the Johannes Gutenberg-University Mainz, Mainz, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chia-Jung","family":"Busch","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology and Head 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