164 | Chapter 6 Discussion This study outlines the development and feasibility testing of the first Dutch multidisciplinary PDA for patients with an early stage OPSCC) who are eligible for both treatment with radiation therapy or transoral (robotic) surgery with or without ND, as a single modality treatment with curative intent. Experts and patients perspectives were carefully considered during the development of this tool, which underwent extensive editing to ensure it was easy to understand, usable, feasible, and well-designed. With the incidence of OPSCC on the rise and a lack of consensus regarding radiation- versus surgery-based treatments, our PDA offers a helpful framework for newly diagnosed patients to make treatment decisions that align with their personal values but also increase their knowledge on the disease, treatment and possibilities. Increasing attention is being given worldwide to the implementation of shared decision-making and associated tools; in the Netherlands this is an important topic in the vision document “Medical Specialist 2025” of the “Federation of Medical Specialists”19. Additionally, a campaign called “Start a Good Conversation” was launched in 2022, focusing on shared decision-making. This collaborative effort involves various organizations including the Federation of Medical Specialists, General Practitioners Association, Ministry of Public Health, Welfare and Sport, Dutch Association of Hospitals, Patients Federation, and Health Insurers20. The campaign offers guidance for healthcare providers and patients to facilitate shared decision-making, as well as opportunities for collaborative development of decision aids and other tools. In the Netherlands, multiple PDAs for several medical purposes have been developed, but for head-and-neck oncology only a PDA for advanced laryngeal carcinoma is available, of which the impact is still being studied11. One could state that decision aid tool development for head and neck cancer is falling behind compared to other oncological diseases21-25. We found that all patients were aware of radiation treatment, but not all were aware of the option of surgical treatment. This is quite interesting considering they were eligible for both, as judged by the multidisciplinary tumor board. It is unclear if both treatments were not discussed, or if patients have forgotten this information, referred to as ‘recall bias’26. Important factors for decision-making for patients were clarity regarding equal survival numbers for these two treatments, focus on differences in short-term side-effects, but most important long-term side-effects. A research group from the Johns Hopkins hospital developed a PDA for OPSCC patients and also found that patients primarily focus on survival. Most of their patients felt well informed by
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