Ietje Perfors

9 standard one-size-fits-all approach. In addition, it is also adjusted to the medical and psychosocial profile of the patient taking into account comorbidity and lifestyle. Finally, personalised treatment is also fitted to the individual needs and preferences of the patient. Patient empowerment and shared decision making are important in the development of personalised care. Patient empowerment is an individual as well as a community process, through which patients gain greater control over decisions and actions affecting their health. 11 In this process patients understand their role and are empowered by their health-care professional. They get the skills and knowledge needed to actively participate in their personal health care, in an environment that encourages patient participation. Shared decision making Shared decision making (SDM) is an important aspect of personalised cancer care. 12 SDM aims at the process “where clinicians and patients share the best available evidence when faced with the task of making decisions, and where patients are supported to consider options, in order to achieve informed preferences”. 13 SDM between patients and healthcare professionals enables weighing the treatment options in the light of patient preferences and personal context. SDM is not only needed as a one-off intervention to enable choice of a tailored treatment, but it is a continuous process, which is required for each decision throughout the cancer continuum. More patient involvement in decision making is demonstrated to improve compliance with treatment, 14 higher quality of life 15 and reduce healthcare costs 16 . In the palliative setting, studies suggest that SDM could improve emotional outcomes in palliative patients. 17 But, presently, SDM is not yet optimally implemented in curative cancer care as is demonstrated by a study with audiotaped decisionmaking consultations for preference-sensitive curative treatment decisions in patients with rectal cancer. The data of this study suggest that oncologists are not explicitly in discussing SDM with their patients. 18 1