Mariken Stegmann

Introduction  Of the estimated 3.9 million new cases of cancer in Europe in 2018, 1  about 75% were in  patients aged ≥60 years. 2  Treatment decisions for such older patients often involve a  complex trade‐off between risks and benefits. This reflects their limited life expectancy,  increased frailty, and greater number of comorbidities, which increase the risk of  complications and functional decline after treatment. 3 Tailored decisions require that a patient’s preferences and goals should be taken into  account. 4  Though most patients with cancer consider shared decision making to be  important, 5  older patients often find this approach difficult. 6  A perceived barrier is that the  expert position of the oncologist leads to a power imbalance in the doctor–patient  relationship. 7  This can lead to feelings of low empowerment in the patient, which makes it  difficult for doctors to estimate the health goals of a given patient. 8  Consequently, personal  preferences may not always be taken into account. 9  Several decision aids have been  developed to rectify this problem, 10  with most being designed to clarify the risks and  benefits of specific diseases and their associated treatments. The non‐specific Outcome  Prioritisation Tool (OPT) has been validated for discussing generic treatment goals, such as  extending life (Figure 1). 11,12 Figure 1. Example of the Outcome Prioritisation (OPT) Tool. Note that in this example of the OPT, the  most important goal for this patient was to maintain independence.  4 41 The OPTion randomised controlled trial