Mariken Stegmann

care providers three important questions (Box 2). SDM should then be stimulated by discussing these; however, research has recently shown that an SDM intervention aimed at patients was ineffective, whereas training health care providers significantly increased the use of SDM. 20 Ask 3 Questions International version 1. What are my options? 2. What are the possible benefits and risks of these options? 3. How likely are the possible benefits and risks of each option to occur? Dutch version (translated) 1. What are my options? 2. What are the possible benefits and risks of those options and how likely are they to occur? 3. What does this mean for me? Box 2. The “Ask 3 Questions” campaign Step 3 of SDM: Discussing patients’ preferences Discussing goals and preferences is not included in the original version of Ask 3 Questions. The Dutch version merges the second and third questions, and adds a new question “What does this mean for me?” (Box 2). This last question is exemplified with the text “Your personal situation is important for your choice: what is your living situation, what is your job, how old are you, and what are your needs and goals?” Discussing this question might lead to a better understanding of patient preference. To the best of my knowledge, no literature has described if this question works and which health care provider is best placed to discuss this question. Patients are often left believing that there is only one viable treatment option, but in most cases, multiple treatment options are available. In these settings, the presented option is often that described as standard care in guidelines, typically offering the highest survival. However, in the OPTion study, we showed that only 29% the older patients with a non ‐ curable malignancy chose extending life as the most important goal (Chapter 4), consistent with other research using the same instrument (Chapter 3). Although research has shown that the main reason for non ‐ adherence is patients preference, 21,22 guidelines often pay little attention to alternative treatment options or patient preferences. 23 Older patients often find it difficult to express their preferences explicitly. 6,7 Sometimes they ask their health care provider to “do what is best for me,” yet as has been shown, health care providers are poor at estimating a patient’s goals. 24 In a recent study, it was shown that agreement was poor between the most important goal according to the health care provider and the most important goal according to the patient, at only 42% for GPs (weighted kappa 0.067; p = 0.39) and 40% for medical specialists (weighted kappa 0.074; p = 0.33). 24 This is consistent with other studies 25,26 and emphasises the importance of explicitly discussing preferences. The OPT can be used to clarify patient goals based on non ‐ disease ‐ specific goals, such as extending life and reducing pain. GPs often have a longstanding relationship with older patients and can be well placed to discuss needs and goals. 15 In the NFK survey, most patients (66%) indicated they thought the GP should discuss the priorities of patients in life and how these affect treatment options when a patients is about to make a treatment decision. 14 Furthermore, as shown in OPTion2 110 Chapter 8