PDA Impact in Advanced Larynx Cancer | 129 5 The PDA The PDA was developed by a team of head and neck surgeons, radiation oncologists, medical oncologists and a dedicated team of patients from two head and neck centers in The Netherlands in 201618, following the International Patient Decision Aid Standards (IPDAS) criteria25,26. After inclusion of usual care was completed, the PDA was published online in Dutch and English (www.beslissamen.nl). Depending on age and TNM stage, patients would see different versions of the PDA depending on whether or not they would be candidates for the various treatment options, including RT, CRT and TL. Based on National Guidelines, chemotherapy was not offered above the age of 70 years27. Outcomes and their likelihood were based on a population-based study28. See figure 1 for an overview of the PDA. Measures Data on patient’s age, educational level, marital status, employment status, family history of head-and-neck cancer, comorbidities, diagnosis, tumor stage, tumor subsite, treatment, adjuvant treatment, were gathered from hospital records. The primary outcome Decisional conflict (DC) was measured with the validated Decisional Conflict Scale (DCS)15,21. As a secondary outcome, we compared Clinically Significant DC (CSDC), with a score >25 serving as the cutoff to distinguish between normal and harmful levels of decisional conflict29–31. Additional exploratory secondary outcomes included shared decision making (SDM), control preference and knowledge. SDM was evaluated using validated Dutch versions of SDM-Q9 for patients and SDMQ-Doc for physicians. Both instruments, with 9 statements each, use a 6-point scale (0 to 5), resulting in scores from 0 (lowest) to 100, wherein higher scores indicate better perceived SDM22–24. Additionally, patients’ desire of involvement in decision making was assessed, using the Control Preference Scale (CPS) 9, for descriptive purposes. A study specific knowledge test was conducted to investigate patients’ knowledge after counseling. It used 20 statements on the different treatment options, which could be rated as “true”, “not true” or “do not know”. The number correct was used as the knowledge score.
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