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This Article Full Text Full Text (PDF) CME: Take the course for this article: Decision Making in Oncology: A Review of Patient Decision Aids to Support P... FREE NURSING CONTACT HOURS All Versions of this Article: CA.2008.0006v1 58/5/293    most recent Submit a letter to the editor View responses Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Stacey, D. Articles by Bennett, C. Search for Related Content PubMed PubMed Citation Articles by Stacey, D. Articles by Bennett, C.

Decision Making in Oncology

A Review of Patient Decision Aids to Support Patient Participation

Dr. Stacey is Assistant Professor, School of Nursing, University of Ottawa, Ottawa, Ontario, Canada.
Dr. Samant is Assistant Professor, University of Ottawa; and Radiation Oncologist, The Ottawa Hospital Regional Cancer Centre, Ottawa, Ontario, Canada.
Ms. Bennett is Research Coordinator, Ottawa Health Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada.

Disclosure: Financial support was provided by a group grant of the Canadian Institutes of Health Research. The funding agreement ensured authors' independence in writing and publishing this report. Dr. Stacey has received research funds from the Foundation for Informed Medical Decision Making. No other conflict of interest relevant to this article was reported.
Published online through CA First Look at http://CAonline.AmCancer.Soc.org.
To earn free CME credit or nursing contact hours for successfully completing the online quiz based on this article, go to http://CME.AmCancerSoc.org.

Although cancer management is becoming more structured with disease- specific guidelines and clinical pathways, many decisions remain complex. Contributing to this complexity is the need to make value tradeoffs between benefits and harms across cancer treatment and/or screening options. Since there is no "best" option for everyone, decisions are defined as being of higher quality when informed with the latest scientific evidence and based on patients' informed values associated with outcomes of options. However, clinicians are not good judges of patients' values, and patients often have inadequate knowledge, unrealistic expectations, and decisional conflict that interfere with their involvement in decision making. Effective approaches to support patient involvement into clinical decisions include clinicians trained in shared decision making, question prompt sheets, patient decision aids, and decision coaching by nurses and other allied health professionals. Based on systematic review of 23 randomized trials of cancer patient decision aids, patients exposed to decision aids are more likely to participate in decision making and achieve higher-quality decisions. This review highlights key historical changes leading to patient involvement in decision making, summarizes evidence on effective interventions to support shared decision making, explores strategies to implement these interventions in oncology practices, and identifies future directions.

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