Identification and synthesis of decision-making factors in vestibular schwannoma treatment

Background: 

Managing vestibular schwannomas (VS) involves complex choices among wait-and-scan, stereotactic radiotherapy, and surgery. Although shared decision-making (SDM) is increasingly emphasized, the factors reported to influence treatment choices remain incompletely characterized. 

Objective: 

This systematic review aims to synthesize reported factors influencing treatment decision-making in VS and inform SDM practices. 

Methods:

In accordance with the PRISMA 2020 guidelines, a systematic literature search was conducted on February 24, 2024, across PubMed, Embase, CINAHL, and Web of Science. Twelve studies were included, comprising patient and/or physician surveys and retrospective chart reviews. Extracted data included patient characteristics, tumor features, physician-related factors, and treatment-related considerations. Levels of evidence were classified using the Oxford Centre for Evidence-based Medicine framework. Most studies were level 4–5, reflecting a predominantly observational and descriptive evidence base. 

Results: 

Tumor size, hearing status, and patient age were frequently reported in association with treatment selection. Psychological factors, including anxiety, reassurance-seeking, and quality-of-life considerations were commonly described in relation to decision-making. Physician factors, such as specialty and communication style, were also reported as relevant. Several studies noted higher satisfaction when patients described active involvement in decision-making and multidisciplinary input. 

Conclusion: 

Decision-making in VS management is multifactorial and highly individualized. Greater emphasis on transparent communication and structured SDM tools may help align treatment decisions with patient preferences. These findings highlight the need for future research focusing on standardized decision aids and the integration of patient-reported outcomes into longitudinal care.