PDA Development for Oropharynx Cancer | 151 6 Due to the Covid-19 pandemic, phase 2 and 3 were performed through video calls and questionnaires were sent via email or post as preferred by participant. Recruitment and inclusion criteria Previously treated patients were recruited by their treating physician and subsequently contacted by the researcher (A.H.). Patients needed to have been eligible for primary radiation therapy or TO(R)S with or without a neck dissection. This was decided during the multidisciplinary team (MDT) meeting, taking into account the patient’s clinical profile, tumor stage and location, imaging results, and pathological examination. A crucial aspect was to minimize the risk of adjuvant treatment after surgery. OPSCCtreating physicians were recruited through peer networking. All participants signed informed consent. Scope of the PDA The PDA was developed for patients facing a single modality treatment choice. The Dutch oral cavity and oropharyngeal carcinoma guideline was published in 2014 and is therefore outdated (update expected to be published in 2023-2024). Involved centers have made their own guidelines based on literature, local resources (e.g. availability of TORS) and experiences. It was therefore decided not to limit inclusion criteria by tumor stage, but to follow the decision of the local MDTs whether a patient was suitable for unimodality treatment (radiation or TO(R)S). The PDA is meant for patients with stage I HPV+ OPSCC and stage I-III HPV- OPSCC where primary tumors are resectable transorally and neck disease is very limited. Data processing and statistics All interviews (in depth, and thinking out-loud sessions) were performed by A.H., who had no treatment relationship with the patients. The interviews were audio-recorded, verbatim transcribed, and anonymized. Thematic coding was done using ATLAS.ti software (version 9.1). Thematic coding leads to the discovery of appropriate content for the decision aid focusing on the decision-making process, experiences around side effects of treatments, knowledge about the disease, (decisional) needs and opinions about the PDA. The results of the questionnaire were quantitative data and are displayed using means, ranges, and percentages. Ethics This study does not fall under the scope of the Medical Research Involving Human Subjects Act and was approved by the review board of the Netherlands Cancer Institute (IRBd18-030).
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