15250-m-cuypers

67 Decision aid development and usability testing 4 BACKGROUND Decision aids (DAs) are tools designed to support the process of shared decision making (SDM) betweenpatients and their clinician 1,2 . DAs canhavemultiple formats (e.g. leaflets, website), but should at least create choice awareness, offer balanced information and stimulate patients to consider their preferences 3 . In general, DAs are associated with increased knowledge, more accurate risk perceptions and more conservative treatment preferences 4 . The International Patient Decision Aids Standards (IPDAS) provides DA developers consensus-based criteria to ensure DA quality 5 . To help DA developers, a checklist is available that includes nine categories to which the DA should comply (e.g. Provide sufficient information about the decision and using high quality evidence) 6 . A particularly fruitful area for the application of DAs is prostate cancer (Pca) care. Pca is the most common cancer in men in the Western world 7 . Pca treatment guidelines do not indicate a single superior treatment option but recommend a shared treatment decision between clinician and patient 8 . However, selecting the best suiting treatment from the available alternatives can be a burden for many patients. The process involves careful consideration of the risks and benefits of multiple treatments and weighing this against preferences and personal characteristics. Decision-making is further complicated by sub-optimal information provision and a possible misinterpretation of patient preferences by clinicians, which emphasizes the potential benefits from DAs in Pca care 9-11 . Recent reviews of Pca DA trials concluded that current Pca DAs provide good quality information andhelp to increase patients’knowledge 12,13 . Despite improved information provision, current DAs do not guarantee that SDM takes place. Moreover, content, format and presentation of Pca information within DAs varied substantially, with many failing to comply to all components of the IPDAS criteria 12, 13 . The most identified shortcomings consisted of not including physicians and patients during DA development, a lack of balanced information on all options and the absence of explanation about the evidence used in the DA 13 . Rather than resolving these issues with current tools, often new tools are developed elsewhere. This further increases the variety and number of available tools, though routine use in clinical practice of these tools remains limited 14 . As many care providers articulated the need for a suitable Dutch DA, we built an interactivewebsitebasedon anexistingevidence-basedonlineCanadianDA, developed by Feldman-Stewart and colleagues 15-19 as a starting point for further development in the Dutch situation. This paper describes the development process of the DA and usability evaluation in Dutch clinical setting.