15250-m-cuypers

9 General introduction 1 GENERAL INTRODUCTION ´If even the doctor does not know which treatment option would be best, how should I then decide what to choose? I am not a doctor, after all´. This could be the perception of a patient after receiving the diagnosis early-stage prostate cancer. In many cases, mild symptoms or an elevated PSA level in a (routine) blood test precede the diagnosis. Consequently, a man in a relative good health condition is suddenly confronted with a cancer diagnosis, which a patient may perceive as a serious and potentially life- threatening disease. Diagnosis can feel overwhelming at such a moment and choice awareness may be lacking. Explanation follows about the disease, its multiple treatment options, the different associated procedures and their potential benefits and side-effects and can cause patients to feel overloadedwith information and to experience high levels of decisional conflict. This example highlights that providing high quality health care consists of more than diagnosing and treating a disease. In many medical situations, including early-stage prostate cancer, multiple appropriate treatment methods are available, as well as an option not to treat (immediately). In case of medically equivalent options, not only the medical content is relevant, but patient preferences and other personal circumstances determine which option provides the best patient-treatment fit. Optimal treatment choice is therefore dependent on shared doctor-patient decision making, consisting of discussion of all options, including the pros and cons so that the patient and doctor together come to a conclusion what would be the best option for this patient. However, this process of shared patient-doctor decision making, beyond the exchange of relevant medical information, is challenging. First, evidence has shown that many patients are dissatisfied with the information they receive, patients sometimes lack choice awareness, or perceive discordance between the experienced and desired level of involvement in the decision process 1-6 . Moreover, health-care providers sometimes misinterpret patient preferences, which may result in treatment choices that are not concordant with patients values, and evidence also reveals that healthcare providers can be prone to overestimating the degree to which they already engage patients in a shared decisionmaking process 7,8 . To properly inform patients, enable them to take a more active role and to stimulate a joint patient-doctor decision process, patient decision aids (DA) can provide assistance in achieving shared decision making in routine clinical care 9, 10 . After exposure to a DA, patients report feeling better informed, are more knowledgeable, and more clear about their personal values 10 .