15250-m-cuypers

111 Decision process parameters 6 BACKGROUND In a clinical area where multiple equal effective treatments are available for the same medical condition, the preference-sensitive treatment selection that is then required can be challenging for patients as well as physicians 1-3 . Treatment selection for localized prostate cancer (Pca), the most commonly detected cancer in men in the Western world, is such an area 4 . When diagnosed at a localized stage, Pca can be managed with equal successful curative treatments (surgery or radiotherapy), or by following an active surveillance (AS) protocol without harming survival perspectives 5-8 . Although oncologically equivalent, treatments differ in their impact on quality of life, risk of side effects and perceived burden, therefore, Pca treatment guidelines do not indicate a single superior treatment option, but recommend shared decision-making (SDM) to come to the best patient-treatment fit 5, 6, 9-11 . Moreover, many Pca patients have a poor understanding of differences in treatment risks prior to choosing treatment, are dissatisfied with information received, and experience regret after treatment 12-14 . With SDM and more decision support these problems can be resolved. SDM requires patients to share preferences, uncertainties, and the desired level of participation in the decision process. A physician should be aware of the patient’s preferred level of involvement and take this into account to adequately provide all available information about eligible options, including risks, benefits and scientific uncertainties 15,16 . However, patient preferences for involvement areoftenmisinterpreted by care providers and many patients are dissatisfied with the information they received 17-20 . To facilitate and improve the process of SDM, patient decision aids (DAs) were developed tohelppatients to increase choice awareness, providehighquality information, structure the decision process, and to help clarify preferences and values 21-23 . Simple DAs are plain paper versions, while more elaborate DAs are built as interactive websites that include explicit values clarification methods 24, 25 . DA effects are typically studied by comparing patient reported outcomes following decision-making between a DA group and a usual care group. In a review of DAs across all medical screening and treatment decisions, it has been shown that DAs contribute to improved patient involvement in the treatment decision, less decisional conflict and more conservative treatment choices 26 . In the specific area of Pca treatment decision-making, DA results are less conclusive. Positive effects are seen for improved patient education (knowledge, information satisfaction), but mixed effects are found for other decision process measures such as decisional conflict 27 . Often the studied Pca DAs did not fully comply with the