Mariken Stegmann

Abstract  Background: Older patients with cancer often find it difficult to take part in shared decision  making.  Aim: To assess the utility of the Outcome Prioritisation Tool (OPT), designed to aid discussion  with a patient in regards to their treatment goals, to empower patients with cancer through  structured conversations about generic treatment goals with GPs.  Design and setting: A randomised controlled trial of 114 Dutch participants recruited  between November 2015 and January 2019, aged ≥60 years with non‐ curable cancer who  had to make a treatment decision with an oncologist. The intervention group used the OPT  while the control group received care as usual.  Method: The primary outcome was patient empowerment using the score on the decision  self‐efficacy (DSE) scale. Secondary outcomes were symptoms measures of fatigue, anxiety,  and depression. The experiences of participants were also explored.  Results: No effect was found on patient empowerment between the OPT group (n = 48; DSE  86.8; standard deviation [SD] = 18.2) and the control group (n = 58; DSE 84.2; SD = 17.6; P =  0.47). In the OPT group, although statistically non‐ significant, fewer patients had low  empowerment (18.8%, n = 9 versus 24.1%, n = 14; P = 0.50), but they did have statistically  significant lower mean anxiety scores (6.0, SD = 4.6 versus 7.6, SD = 4.4; P<0.05) and less  mild fatigue (58.8%, n = 30 versus 77.2%, n = 44; P = 0.05). Overall, 44.8% (n = 13) of patients  indicated that the OPT‐ facilitated conversation helped them make a treatment decision, and  31.1% (n = 14) of the GPs reported that they gained new insights from the conversation.  Conclusion: An OPT‐facilitated conversation about generic treatment goals between patients  and their GPs is associated with less anxiety and fatigue, but did not show statistically  significant improvements in patient empowerment. Adding the OPT to routine care might  ensure more patient‐tailored care.  40 Chapter 4