15250-m-cuypers

71 Decision aid development and usability testing 4 comments was discussed by the development team to determine the implications for DA adjustments. If consensus was reached on the need for changes, this led to final adjustments in the DA. Stage 6: Final adjustments Usability testing resulted in final adjustments to the DA (described in Results section). Finally, the DA was evaluated for compliance with the IPDAS criteria 6 . RESULTS Decision aid Stage 1 resulted in a plain text translation of the original Canadian DA on a prototype website. From the observations of conversation flow in clinical practice (stage 2) it was learned that following diagnosis clinicians often do not go into detail about all treatment options immediately. If eligible for active surveillance, treatment options are first presented as a consideration between active surveillance and curative treatment, before curative treatments options are discussed in more detail. In order to tailor the DA to this typical conversation flow during consultation, the DA was designed into four steps. Table 1 provides an overview of all topics covered in DA steps 1 to 3. DA step 1: General Pca information This introducing step provides background information about Pca in general. The anatomy of the prostate and the commonly used terms PSA and Gleason are explained. DA step 2: Active surveillance versus curative treatment The pros and cons of not treating immediately are compared to (immediate) curative treatment (Table 1). Specific treatment characteristics are not yet discussed in detail. Step 2 ends with VCEs on topics that require trade-offs between curative treatment and AS (Table 2). DA step 3: Surgery versus radiotherapy If patients are still undecided or have a preference for curative treatment following step 2 they continue to step 3. This step explains the difference between surgery and radiotherapy in more details (Table 1). An example page from this step is provided in figure 1. Patients who already prefer AS after step 2 are allowed to skip this step. Step 3 endswithVCEs on topics that differentiate between surgery and radiotherapy (Table 2). If patients already indicated a preference for AS in step 2, continuingwith step 3 is optional.