PDA Impact in Advanced Larynx Cancer | 139 5 Discussion To our knowledge, this is the first prospective multicenter study evaluating the impact of a patient decision aid tool for patients with advanced laryngeal cancer. The results clearly indicate that introducing the PDA resulted in lower total DCS scores. Additionally, the intervention arm demonstrated significantly better knowledge about the possible treatments and scored significantly higher for perceived shared decisionmaking compared to patients receiving usual care. By providing comprehensive information and supporting patient involvement in the decision-making process, this PDA empowers patients with advanced laryngeal carcinoma to make informed decisions. The observed significant reduction in total DC scores among participants who utilized the PDA was noteworthy and indicative for improvement in their decision-making process. However, reduction in mean DC resulted mostly from a narrower range, i.e., lower maximal scores, and despite this improvement, the proportion of patients with CSDC was not significantly different between the groups. This finding might be related to the choice of cut-off for CSDC. In recent years, there has been an increased adoption of cut-off values for DC in clinical practice. Scores below 25 are often associated with the ability to implement a decision, whilst scores above 37.5 are indicative for decision delay. Consequently a threshold of ≥25/100 is most often defined a cutoff for CSDC21. These thresholds offer a quantitative framework for assessing the clinical relevance of DC. However, it’s important to recognize that the utility of these cut-offs beyond their original context has not been extensively explored and for specifically life changing decisions in cancer treatment, different cutoff values might be clinically relevant33. Our study showed a significant difference in treatment knowledge between the intervention and usual care groups. Despite expectations that, after ending treatment, the knowledge gap would diminish, the difference in knowledge persisted at six months post-treatment. This underscores the enduring benefits of targeted educational interventions. Such interventions not only facilitate immediate comprehension but also support long-term coping with the outcomes of complex treatments like TL. The enhancement in perceived SDM levels within the intervention group aligns with our expectations. This improvement is probably due to the comprehensive nature and the audiovisual aspects of the information provided to these participants, covering all available treatment options. In contrast, the usual care group’s knowledge and experience on the decision process largely depends on the specific information their
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