PDA Development for Oropharynx Cancer | 165 6 their physicians, whereas our patients felt overwhelmed and the used language was too technical and therefore too difficult12, 27. Another PDA for OPSCC has been developed in Ontario28. They developed the PDA with healthy volunteers and focused on their treatment preference, showing a preference for TORS above radiation, based on the side-effects. Our study reveals that both patients and physicians perceive the PDA as a valuable supplement to traditional counseling. However, notable distinctions arise between physicians and patients. Physicians tend to prefer offering extensive information, whilst patients express concerns about information overload. On the other hand, physicians report perceiving the time required to utilize the decision aid as relatively high, whereas patients rate it favorably. Once again, this underscores the importance of collaborative efforts between physicians and patients, particularly considering the substantial evidence indicating that patients and physicians prioritize different aspects of disease and treatment29-31. Physicians were satisfied with the results and most of all with the use of videos and graphics. For successful utilization, an effective implementation plan is crucial, particularly in determining how the PDA will be used: whether during counseling sessions with doctors, in collaboration with specialized nurses, or even in the comfort of one’s home. Evaluation of patients’ preferences is a difficult task and is quite often overlooked or forborne in the era of national guidelines and results from multidisciplinary meetings in which strong emphasis is placed on survival outcomes. Furthermore, treatment choices can be highly dependent on the type of information provided during counseling. As physicians have limited consultation time, and physicians find it difficult to assess patients’ treatment preferences, levels of shared decision-making are low32, 33. This might result in decision regret since patients are not aware of treatments and might undergo a treatment that is not fitting their preferences34, 35. Tools like this PDA will be a perfect solution to bridge this gap. Limitations As a result of the COVID-19 pandemic, our study was limited to including patients solely from The Netherlands Cancer Institute. Additionally, the second and third phases had to be conducted remotely via phone or digital means, although the ideal scenario would have been in-person interactions. Literature comparing TORS and radiotherapy in this type of OPSCCs was scarce during the first phase of this study. A more recent study (which was not available during the development of this PDA) about long-term results of the ORATOR trial showed that swallowing difference between primary radiotherapy and TORS approaches persists but decreases over time8. It is worth
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