15250-m-cuypers

15 General introduction 1 path to navigate patients through this step. Nurses often have more time available for counseling patients compared to doctors, and patients can perceive less of a power imbalance in conversation with a nurse 50 . After all options and patient values have been explored, the aim of the Decision talk is to make the treatment decision. Pca patients usually have this decision talk with their urologist. Patient Care provider Pca diagnosis and choice awareness (Team talk) Choice of treatment ( Decision talk) Pca treatment Treatment counseling (Option talk) Shared decision making: Reviewing options and establishing informed preference Display of options for treatment Reviewing options and reaching informed preferences Figure 3. Three steps in SDM models, with the Three Talk model 49 . Decision aids Even with stepwise models such as the Three Talk Model described above, it can be difficult for patients and doctors to initiate SDM and engage in a shared decision making process. Patients are often unaware that multiple options are available and that their preferences matter to select their personally optimal treatment option 51 . Doctors frequently misinterpret the desired level of patient involvement and overestimate the extent of SDM they already display 52-54 . To overcome these barriers in the execution of SDM, a variety of decision support interventions have been developed, of which decision aids (DAs) are the most comprehensive 55 . DAs come in multiple formats, ranging from concise paper leaflets to elaborate online tools. Regardless of their format, DAs provide balanced information about treatment options, with equal attention for the advantages and disadvantages of all options. DAs aim to help patients achieve an informed treatment preference. Some DAs therefore include implicit or explicit exercises to help patients to clarify personal values 9, 10, 56 . Quality criteria to guide DA development are provided by the International Patient Decision Aids Standards (IPDAS) collaboration 56, 57 .