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

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.