Decision regret and satisfaction with shared decision-making in pancreatic surgery

Background: Pancreatic surgery often does not provide long-term survival in patients with cancer or consistently improve symptoms in benign disease. This study aimed to assess decision regret and satisfaction with the decision-making process among patients who underwent pancreatectomy. Methods: This study administered the Brehaut Decision Regret Scale (DRS), 9-Item Shared DecisionMaking Questionnaire (SDM-Q-9), and the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30) to all patients who underwent elective pancreatectomies from 2021 to 2023. Decision regret was defined as a DRS of > 25. In addition, this study evaluated SDM-Q-9 responses in patients with and without regret. Results: A total of 143 patients were included in this study, of whom 71 patients (49.6%) completed the distributed surveys. Demographics, pathology, and major complication rates were similar between responders and nonresponders. The indications for surgery were malignancy (67.6%) and benign disease (32.4%). Decision regret after pancreatic surgery was reported in 18.3% of patients. Patients who experienced regret were younger (50.8 +/- 18.7 years [younger group] vs 62.0 +/- 14.9 years [older group]; P = .03), more likely to have benign disease (39.1% [benign disease] vs 8.3% [malignant disease]; P < .01), underwent a distal pancreatectomy (34.5% [distal pancreatectomy] vs 7.7% [pancreaticoduodenectomy]; P = .02), or experienced a major complication (36.8% [major complication] vs 11.5% [no major complication]; P = .03). Patients with regret had lower global health (57.1 +/- 20.1 [patients with regret] vs 76.2 +/- 22.2 [patients without regret]; P < .01) and social function scores (61.5 +/- 31.5 [patients with regret] vs 77.6 +/- 22.0 [patients without regret]; P = .03) on the EORTC QLQ-C30. Patients with regret were less satisfied with the shared decision-making process. Conclusion: Strong decision regret was reported in 18% of patients who underwent pancreatectomy. Younger age, distal pancreatectomy, benign indications, and major postoperative complications were associated with regret. Data from the SDM-9 highlight areas for potential improvement to help patients make decisions aligned with their goals of care. (c) 2024 Society for Surgery of the Alimentary Tract. Published by Elsevier Inc. All rights are reserved, in