Qualitative study examines uncertainty in 12 vestibular schwannoma surgery patients

Patients preparing for surgery for vestibular schwannoma described the period after diagnosis as a process of rebuilding certainty, agency and a sense of meaning. In semi-structured interviews with 12 people who had undergone surgical resection within the previous five years, researchers identified four connected themes: biographical disruption, meaning-making, healthcare interactions that shaped uncertainty, and surgical decision-making as emotional, relational and moral work. The qualitative study examined how patients processed their diagnosis before treatment rather than assessing clinical outcomes or comparing surgical and nonsurgical options.

The diagnosis was described as a sudden event that challenged participants’ sense of normality, identity and expectations for the future. Rather than treating treatment selection as the whole preoperative experience, the interviews show that participants were also trying to interpret what the diagnosis meant for their lives. They sought information, exchanged experiences with peers and reconsidered events from their past as part of an attempt to regain control. The researchers characterized this as meaning-making: an active effort to reconstruct certainty and agency in circumstances that initially appeared difficult to define.

Healthcare encounters were another central element of that process. Patients reported that communication quality, empathy and consistency shaped their confidence and emotional stability. These accounts suggest that the way information was communicated could influence how uncertainty was experienced during the preoperative period. The finding comes from participants’ retrospective descriptions in a small qualitative sample, however, and it does not establish that a particular communication technique improves decision quality, treatment preference or clinical outcomes. Instead, the interviews identify communication as a regulator of uncertainty within the accounts given by patients.

Choosing surgery was similarly portrayed as more than selecting a procedure. Participants had to negotiate fear, trust, responsibility and the burden of choices with potentially irreversible consequences. The researchers described this stage as emotional, relational and moral work, emphasizing that surgical decision-making required patients to manage not only medical information but also their relationships and their sense of what they could responsibly bear. Because every participant underwent surgical resection, the study does not show how people who selected monitoring or another treatment approached the same pressures. It also cannot establish that surgery itself produced the changes in identity, certainty or agency reported by participants.

Based on these findings, the researchers concluded that patient-centered care for vestibular schwannoma should combine clear information with empathetic communication and support for the emotional and moral dimensions of treatment choice. The recommendation follows the study’s qualitative design and the themes that emerged from the interviews; it does not demonstrate the effectiveness of a specific counseling program, decision aid or communication protocol. The sample was small, retrospective and restricted to patients who had already undergone surgery, limiting broader conclusions and making the accounts primarily reflective of how participants understood their preoperative experience. Nevertheless, the interviews reveal a phase often obscured by discussions limited to symptoms and treatment outcomes: a period in which patients actively work to restore meaning, manage uncertainty and consider how much responsibility they can carry for an uncertain future.

Subject of Research: Preoperative uncertainty, agency and treatment decision-making among 12 vestibular schwannoma surgery patients

Article Title: Negotiating uncertainty and responsibility after a vestibular schwannoma diagnosis: a qualitative study of meaning-making and surgical decision-making

Article References: Rutenkröger, M., Nieke, N., Brandes, L., & Scholl, I. (2026). Negotiating uncertainty and responsibility after a vestibular schwannoma diagnosis: a qualitative study of meaning-making and surgical decision-making. BMC Psychology, 14(1), Article 1289. https://doi.org/10.1186/s40359-026-05506-1

Image Credits: AI Generated

DOI: 10.1186/s40359-026-05506-1

Keywords: vestibular schwannoma, qualitative research, patient decision-making, healthcare uncertainty, surgical choice, meaning-making, patient agency, clinical communication, Negotiating, uncertainty, responsibility, vestibular