Mariken Stegmann

Introduction Shared decision making (SDM) is recommended for patients facing difficult treatment  decisions. 1,2  SDM is defined as “a process to make decisions that are shared by clinicians and  patients by informing patients using best evidence about risks and benefits including patient‐ specific characteristics and values”. 3  There is evidence that an SDM process leads to  enhanced knowledge of treatment options and outcomes among patients 4,5  and better  congruence between pursued treatment options and patients’ personal values. 5  Many  patients prefer a shared role in decision‐making, 6,7  and studies show that patient  preferences vary and physicians notions of patient preferences are often incorrect. 8,9 However, patients’ values and personal preferences are not routinely integrated in clinical  care.[1] Older patients, however, often find it difficult to participate in SDM. 10 In the last decade, several tools have been developed to facilitate SDM. 4,5  Most of these  tools are disease‐specific and focus on explaining the costs and benefits of different  treatment options, sometimes also taking into account personal values and preferences. An  encompassing, non‐disease‐specific tool is the Outcome Prioritisation Tool (OPT), 11  a  decision aid to discuss meaningful goals and preferences with older patients. In the  Netherlands, the OPT is used increasingly in both primary and secondary care to guide  complex decision making (e.g. on trans catheter aortic valve replacement (TAVR), start of  dialysis, and cancer treatment). To summarise the available evidence about the OPT, we  performed a literature review. First, we will describe the instrument and the clinical  experiences and thereafter the results of this mini review.  The Outcome Prioritisation Tool (OPT)  The OPT is an instrument with four visual analogue scales, each representing a universal  health outcome (Figure 1). The healthcare provider invites the patient to value and prioritise  the different outcomes. Each outcome can be rated 0‐100, with a higher score meaning  higher importance. Two outcomes cannot be rated equally.   The OPT can aid with, but not substitute for a conversation. The guideline for healthcare  providers for use of the OPT is described below: 12,13 1. Introduce the instrument and explain the reason for using the instrument.   2. Explain the different health outcomes to the patient.  ● Extending life.  ● Maintaining independence.   ● Reducing or eliminating pain.  ● Reducing or eliminating other symptoms, such as dyspnoea, nausea or  itching.   3. Explain the trade‐off principle: outcomes have to be prioritised in order of  importance, if a patient prioritises one outcome (for example extending life), this  means that they are willing to give up something on another outcome (e.g.  maintaining independence).  4. Invite the patient to prioritise the health outcomes. During this process, patients are  invited to explain what is important to them and why specific choices are made.  5. Check whether the results actually describe the patient’s preferences.  3 31 Review about the Outcome Prioritisation Tool