217 Discussion is easy and straightforward to implement in digital tools, making it a practical and efficient method for assessing patients’ unique experiences regarding subjective cognitive functioning. A potential next step in the assessment of subjective patient experiences is to conduct qualitative research, such as (semi-)structured interviews, with patients with BMs. This approach would allow for a more comprehensive exploration of topics that hold significance for them. Currently, only one qualitative study has been conducted to assess treatment expectations in patients with BMs from lung cancer planned to undergo WBRT.31 However, given the evolving healthcare landscape and the significant changes in treatment options over the years, it would be highly valuable to conduct qualitative research in a larger cohort of patients with BMs and their caregivers who are planned for SRS. Findings from such qualitative studies could subsequently guide future research into treatment-related sideeffects to incorporate these patient-identified factors. Another approach could involve a stepwise qualitative research process. This process aims to determine if existing outcome measures adequately capture the most significant difficulties for patients with BMs. For example, a recent study assessed whether a specific QoL questionnaire captured the most important side-effects as experienced by patients with BMs from lung cancer.32 Ultimately, this can lead to improved alignment between research outcomes and the outcomes of interest to patients and their caregivers. Conclusively, understanding patients’ values regarding treatment and their personal goals can help clinicians discuss these issues with patients and provide appropriate information and can aid selection of appropriate outcome measures for research. It is notoriously difficult to find a good correlation between objective and subjective measures of cognitive performance.33,34 The same was observed in our patient sample in Chapter 3 and 4 where the specific cognitive domains for which patients reported subjective cognitive problems did not completely align with the objectively identified cognitive difficulties in the same sample. However, in Chapter 4, we did observe consistency between the number of patients reporting subjective cognitive decline and those demonstrating objective cognitive decline. Patients may have reported subjective difficulties in attention, while these were objectively reflected by worse memory performance. This emphasizes that although patients may use different labels to describe their cognitive performance, they do notice these cognitive changes in their daily lives following cranial radiotherapy. Thus, while we cannot rely on the exact content of cognitive complaints, the mere presence of cognitive complaints or changes in complaints do hold considerable significance. 9
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