PDA Development for Oropharynx Cancer | 155 6 None of the interviewed Head-and-Neck Surgeons (HNS) used counseling materials during their consultations. Some of them use patients’ scans or drawings to clarify where the tumor is situated, and explain treatments. Radiation Oncologists (RO) did have flyers and brochures about radiation in the HN area, however, used them rarely. Physicians Five HNS and five RO were included from four Dutch Head-and-Neck centers. Interviews lasted on average 26 minutes (range 22 – 35). All agreed that a PDA would be a valuable addition for the decision-making process in this group, and that the main goal should be to avoid multimodality treatment to minimize treatment morbidity. There were different opinions regarding the occurrence of side effects and their severity. Patients Ten patients were interviewed, which lasted on average 36.21 minutes (range 21.5850.08). All patients initially stated that survival is the most important in decisionmaking, but after hearing survival is similar regardless of treatment modality, sideeffects were mentioned as the leading factor in choosing treatment. Prototype development PDA The results of the selected literature, counseling materials and interviews were used to develop the first draft of the PDA. See figure 2. Phase 2: Alpha testing of the Comprehensibility and usability Experts Sixteen experts evaluated the first draft, each focused mainly on their specialty (see table 3). There was a discussion about HPV-status, and it was decided to make three versions of the PDA (HPV positive, negative, unknown) in which there would be different information regarding the etiology, risk factors, and survival. For HPV status ‘unknown’, survival numbers for HPV positive and negative are displayed. On a scale of 1 to 10 (worst to best, where ≥5.5 is sufficient) this draft of the PDA was rated 7.1 (median, range 6.0-7.5). Patients Fourteen patients went through the PDA during a thinking-out-loud session and completed a questionnaire. The PDA was rated as an easy-to-navigate website. They rated this draft a 7.9 (median, range 7.5-9.5).
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