Patient Perspectives of Quality Compared to Quantity of Life Regarding Orbital Exenteration
Bibliographic record
Abstract
OBJECTIVE: Orbital exenteration (OE) impacts patients cosmetically, functionally, and psychosocially. Eye-sparing strategies with the advent of immunotherapy have developed the potential to avoid OE but may result in suboptimal oncologic outcomes and reduced survival. This study assesses patients' perceptions regarding quantity versus quality of life when considering OE compared to alternative treatment modalities. STUDY DESIGN: Mixed-methods study, utilizing quantitative health utility tasks and qualitative patient interviews. SETTING: Tertiary care center. METHODS: Fifty-one patients previously treated for head or neck cutaneous malignancies completed interviews utilizing well-established methodology to assess health state utility values (HSUVs) through time trade-off and standard gamble tasks. This methodology assessed the level of risk patients would be willing to accept to avoid OE in the context of alternate treatment options. Open-ended discussions regarding factors influencing decision-making facilitated an inductive qualitative analysis highlighting patient priorities. RESULTS: Patients were willing to accept 40.6% ± 28.7% risk of death or give up 3.2 ± 2.8 years of survival to avoid OE. This translated to an HSUV for OE of 0.68. The main factors influencing treatment decisions were (1) family, (2) healthcare perceptions, (3) age, (4) social consequences, and (5) risk tolerance. CONCLUSION: The consequences of OE on patients' quality of life impact their decision-making. Patients may be willing to accept relatively high levels of risk to avoid OE. This highlights the importance of eye-sparing strategies and shared decision-making to ensure patient-centered care, which may not be solely prioritized to survival when it comes to OE.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.018 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".