Patient-reported factors that influence the vestibular schwannoma treatment decision: a qualitative study

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.

Shared decision-making in neurosurgery: a scoping review

“…Finally, a total of 42 articles were assessed in full text for eligibility, whereof 18 studies were excluded due to not assessing SDM and 2 studies for not being original articles. This resulted in the inclusion of 22 studies: 14 studies identified through literature searches [ 2 , 6 , 16 , 23 , 25 , 28 , 29 , 32 , 35 , 39 , 51 – 53 , 57 ] and 8 articles through screening of reference lists [ 1 , 5 , 11 , 22 , 34 , 42 , 43 , 54 ] (see Tables 1 and 2 , respectively and see the PRISMA flowchart for more information (Fig. 1 )).…”

“…Of the 22 articles included, 7 focused on SDM in patients with vestibular schwannomas [ 6 , 16 , 28 , 29 , 34 , 35 , 39 ], 6 involved patients undergoing spinal surgery (lumbar herniated disk, lumbar spinal stenosis, spinal stenosis) [ 1 , 2 , 22 , 32 , 42 , 54 ], and 4 included patients with gliomas [ 5 , 11 , 25 , 57 ]. The remaining articles concerned brain metastases, benign brain lesions, Parkinson’s disease, evaluation of neurosurgical care, and one case report on cervical spinal stenosis.…”

“…Factors influencing patients’ decisions include the perceptions and expectations of a total of 3127 patients over 14 articles [ 5 , 6 , 11 , 22 , 23 , 28 , 29 , 34 , 35 , 42 , 43 , 53 , 54 , 57 ]. Methods used to evaluate the SDM process were questionnaires in 11, semi-structured interviews in two, and one study used focus groups.…”

“…The articles in the field of neurooncology range from more biologically benign lesions to high-grade gliomas [ 43 , 52 ]. Vestibular schwannoma was the most common tumor in which SDM was used in the decision-making process [ 16 , 28 , 29 , 35 ], perhaps due to the different treatment modalities available (radiosurgery, surgery, radiotherapy, and wait-and-scan) [ 15 , 43 ]. The treatment of vestibular schwannoma is associated with specific risks and selection of the optimal modality is a careful process [ 4 , 55 ].…”

The impact of vestibular schwannoma and its management on employment

“…This cross-sectional study was part of a more extensive study on long-term VS outcomes in the Netherlands. Participating patients from a questionnaire study in 2014 were reapproached for participation [15]. All patients were diagnosed with unilateral VS between 2003 and 2014.…”