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Background <p>Curative-intent pancreatectomy for pancreatic ductal adenocarcinoma (PDAC) carries high rates of morbidity and recurrence. Patients with operable PDAC face a complex decision of whether to pursue resection. Factors impacting the decision-making process and decisional regret (DR) are relatively unexplored.</p> Patients and Methods <p>Patients with PDAC who underwent curative-intent pancreatectomy at least 6 months prior to study recruitment completed validated surveys assessing DR, health literacy, shared decision-making, and quality of life.</p> Results <p>Overall, 60 patients (48% female) completed all surveys. Postoperative DR (DRS &gt; 1) was reported in 21 (35%) patients. The median time from surgery to survey completion was 55 months in the DR Present group and 33 months in the DR Absent group (<i>P</i> = 0.895). Receipt of systemic therapy, operative characteristics, and postoperative course were similar between groups. The DR Present group had lower rates of obtaining advanced educational degrees (48% versus 76%, <i>P</i> = 0.031), lower health literacy (BRIEF score 14.8 ± 4.2 versus 17.0 ± 2.5, <i>P</i> = 0.014), and greater discordance between preferred and actual roles in the decision making process (Cohen’s kappa 0.672 [95% CI 0.530–0.814] versus 0.912 [95% CI 0.852–0.972], <i>P</i> &lt; 0.001). The DR Present group reported worse physical ability (EORTC score 77.8 ± 21.8 versus 91.3 ± 11.8, <i>P</i> = 0.014), functional role (EORTC score 63.5 ± 33.2 versus 85.5 ± 27.6, <i>P</i> = 0.008), and social activity (EORTC score 65.9 ± 35.9 versus 85.9 ± 21.4, <i>P</i> = 0.026) scores.</p> Conclusions <p>Lower health literacy and discordance in preferred and actual decision-making roles negatively impacts post-pancreatectomy DR. Adequate preoperative counseling on potential quality of life changes is critical for informed decision-making.</p>

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Assessing Clinical Factors and Communication Barriers Impacting Postoperative Regret in Patients with Pancreatic Cancer

  • 期刊论文

  • 发表日期：

    2025年12月16日

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  • Judy Li,
  • Thomas M. Li,
  • Adam Geffner,
  • Sophie Neugarten,
  • Camilo Correa-Gallego,
  • Joshua Leinwand,
  • Neha L. Lad,
  • Ganesh Gunasekaran,
  • Spiros Hiotis,
  • Myron E. Schwartz,
  • Parissa Tabrizian,
  • Umut Sarpel,
  • Daniel M. Labow,
  • James O. Park,
  • Noah A. Cohen

摘要

Background

Curative-intent pancreatectomy for pancreatic ductal adenocarcinoma (PDAC) carries high rates of morbidity and recurrence. Patients with operable PDAC face a complex decision of whether to pursue resection. Factors impacting the decision-making process and decisional regret (DR) are relatively unexplored.

Patients and Methods

Patients with PDAC who underwent curative-intent pancreatectomy at least 6 months prior to study recruitment completed validated surveys assessing DR, health literacy, shared decision-making, and quality of life.

Results

Overall, 60 patients (48% female) completed all surveys. Postoperative DR (DRS > 1) was reported in 21 (35%) patients. The median time from surgery to survey completion was 55 months in the DR Present group and 33 months in the DR Absent group (P = 0.895). Receipt of systemic therapy, operative characteristics, and postoperative course were similar between groups. The DR Present group had lower rates of obtaining advanced educational degrees (48% versus 76%, P = 0.031), lower health literacy (BRIEF score 14.8 ± 4.2 versus 17.0 ± 2.5, P = 0.014), and greater discordance between preferred and actual roles in the decision making process (Cohen’s kappa 0.672 [95% CI 0.530–0.814] versus 0.912 [95% CI 0.852–0.972], P < 0.001). The DR Present group reported worse physical ability (EORTC score 77.8 ± 21.8 versus 91.3 ± 11.8, P = 0.014), functional role (EORTC score 63.5 ± 33.2 versus 85.5 ± 27.6, P = 0.008), and social activity (EORTC score 65.9 ± 35.9 versus 85.9 ± 21.4, P = 0.026) scores.

Conclusions

Lower health literacy and discordance in preferred and actual decision-making roles negatively impacts post-pancreatectomy DR. Adequate preoperative counseling on potential quality of life changes is critical for informed decision-making.