140 | Chapter 5 physicians choose to share. This variability can be attributed to individual doctors’ preferences and their comfort level with SDM practices4. Furthermore they may not be aware of their shortcomings in facilitating an SDM approach, something we also saw in the high level of SDM scored by the physician, irrespective of the use of the PDA34–36. An interesting finding is the disparity in choosing non-surgical treatment between the intervention arm (78.2%, 36 patients) and the usual care arm (62.3%, 28 patients), suggesting a potential influence of the PDA. However, drawing definitive conclusions is challenging since we lack data on patients’ initial preferences before counseling or PDA use, making it difficult to ascertain the true impact of these interventions on treatment choices. Nonetheless, these findings underscore the potential of PDAs in healthcare decision-making, prompting further exploration and integration into clinical practice. In comparison to the existing literature our PDA demonstrates a relatively favorable performance37. While a significant number of PDAs successfully improve patient knowledge, their effect on reducing decisional conflict is less consistent. This difference may be related to the complexity of medical decisions involved 38,39. A systematic review investigating the effectiveness of PDAs in cancer-related decisions showed that most studies have similar results as we have found, indicating that PDAs are an improvement in cancer care40. This review did not include studies with head-and-neck cancer patients, making it difficult to compare studies. Specifically since head-and-neck cancer patients are frailer than patients with other solid malignancies41. Despite the study’s promising outcomes, integrating PDAs into clinical practice poses notable challenges37. The gap between the potential benefits observed in research settings and actual deployment of PDAs in daily patient care highlights the complexities involved in adopting these tools on a routine basis. Factors such as logistical barriers, healthcare providers’ attitudes, patient preferences, and institutional policies play a critical role in this challenge42. To bridge this gap, targeted efforts are necessary to overcome the hurdles to PDA implementation. This involves training healthcare providers in SDM and the effective use of PDAs, continues improvement and updating of the PDA, adapting clinical pathways to accommodate these tools, and fostering a culture that prioritizes patient involvement in decision-making42,43. Addressing these issues is crucial for ensuring that PDAs reach their full potential in supporting patients throughout their healthcare journey, making informed decisions a standard part of patient care.
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