The relationship between role preferences in decision-making and level of psychological distress in patients with head and neck cancer. 
Is there a relationship between decision-making preferences and psychological distress?  Patients who had received treatment for head and neck cancer (HNC) at four institutions within NSW, Australia were invited to complete a single questionnaire.  Five hundred and ninety-seven patients completed the questionnaire.  The majority of patients (308, 54%) preferred shared decision making.  Significant predictors of a preference towards active decision making were education level (OR 2.1 for tertiary, p < 0.001), primary cancer site (OR 1.9 for thyroid compared to salivary gland, p = 0.024) and gender (OR 1.4 for female, p = 0.028).  Mean psychological distress score on Kessler 6 (K6) was 9 (Range: 0-28).  Significant predictors of psychological distress were age (p < 0.001), gender (p < 0.001), primary site (p < 0.01), and decision preference (p < 0.01).  HNC patients who are either tertiary educated or female are more likely to prefer active involvement in decision-making.  Psychological distress is more likely in patients actively involved in decision making, younger patients, and in females.  Patients experienced paternalistic decision-making, but most preferred active or a shared approached.  Clinicians need to be aware of potential for psychological distress in active decision-makers and refer patients for psychosocial support.