Mariken Stegmann
Introduction Shared decision making (SDM) is recommended for patients facing difficult treatment decisions. 1,2 SDM is defined as “a process to make decisions that are shared by clinicians and patients by informing patients using best evidence about risks and benefits including patient‐ specific characteristics and values”. 3 There is evidence that an SDM process leads to enhanced knowledge of treatment options and outcomes among patients 4,5 and better congruence between pursued treatment options and patients’ personal values. 5 Many patients prefer a shared role in decision‐making, 6,7 and studies show that patient preferences vary and physicians notions of patient preferences are often incorrect. 8,9 However, patients’ values and personal preferences are not routinely integrated in clinical care.[1] Older patients, however, often find it difficult to participate in SDM. 10 In the last decade, several tools have been developed to facilitate SDM. 4,5 Most of these tools are disease‐specific and focus on explaining the costs and benefits of different treatment options, sometimes also taking into account personal values and preferences. An encompassing, non‐disease‐specific tool is the Outcome Prioritisation Tool (OPT), 11 a decision aid to discuss meaningful goals and preferences with older patients. In the Netherlands, the OPT is used increasingly in both primary and secondary care to guide complex decision making (e.g. on trans catheter aortic valve replacement (TAVR), start of dialysis, and cancer treatment). To summarise the available evidence about the OPT, we performed a literature review. First, we will describe the instrument and the clinical experiences and thereafter the results of this mini review. The Outcome Prioritisation Tool (OPT) The OPT is an instrument with four visual analogue scales, each representing a universal health outcome (Figure 1). The healthcare provider invites the patient to value and prioritise the different outcomes. Each outcome can be rated 0‐100, with a higher score meaning higher importance. Two outcomes cannot be rated equally. The OPT can aid with, but not substitute for a conversation. The guideline for healthcare providers for use of the OPT is described below: 12,13 1. Introduce the instrument and explain the reason for using the instrument. 2. Explain the different health outcomes to the patient. ● Extending life. ● Maintaining independence. ● Reducing or eliminating pain. ● Reducing or eliminating other symptoms, such as dyspnoea, nausea or itching. 3. Explain the trade‐off principle: outcomes have to be prioritised in order of importance, if a patient prioritises one outcome (for example extending life), this means that they are willing to give up something on another outcome (e.g. maintaining independence). 4. Invite the patient to prioritise the health outcomes. During this process, patients are invited to explain what is important to them and why specific choices are made. 5. Check whether the results actually describe the patient’s preferences. 3 31 Review about the Outcome Prioritisation Tool
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