PhD defence A. (Arta) Hoesseini

Below is a brief summary of the dissertation: 

The decision-making process in the consultation room can be challenging, particularly in the context of life-threatening diseases such as head and neck cancer. Counseling patients requires a personalized approach, tailored to their individual wishes and needs. Our aim was to improve decision-making and to empower patients.

Physicians frequently overestimated survival in the palliative phase. Moreover, prognosis was rarely discussed explicitly during counseling: instead, qualitative terms such as “good prospects” were typically used. Nearly half of the patients experienced decisional conflict after counseling.

Focus groups with patients showed that general prognostic information, such as “curable,” provided sufficient reassurance for most. There was a stronger preference for receiving quantitative prognostic information, such as survival probabilities, in case of a poor prognosis. These insights led to the further optimization of OncologIQ, a prognostic model that calculates the individual survival chances of patients with curative head and neck cancer. The model was externally validated and updated by adding new predictors such as smoking status and BMI. Patients preferred a pie chart to visualize their survival chances. In addition, a separate model was developed for patients in the palliative phase.

Implementation of OncologIQ in the consultation room resulted in significantly less decisional conflict and regret among patients, and a more active role in the decision-making process. In addition, the model provided support to healthcare professionals in complex cases during the multidisciplinary consultation meetings.

In conclusion, this dissertation demonstrates how personalized prognostic information can empower patients, support physicians, and substantially improve the shared decision-making process.