# Decision aids built into the record for every preference-sensitive cancer choice

Source: https://onco.cc/ideas/idea-acc-embedded-decision-aids/  
OnCo record `idea-acc-embedded-decision-aids` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Choices like mastectomy versus lumpectomy, or whether to have chemotherapy after surgery, depend on what matters to the patient. Good decision aids exist but are rarely used; building them into the clinic workflow would change that.

## Summary

Decision aids improve knowledge, reduce decisional conflict, and often shift choices toward less intensive treatment in randomised trials, yet routine use is rare. Embedding validated aids into the electronic record so that they are triggered at the relevant decision point, pre-populated with the patient's own risk estimates, and documented as part of consent would make shared decision-making the default rather than an add-on.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: Embedding decision aids will increase documented shared decision-making for defined choices from under 30% to above 80% of eligible consultations and reduce decisional regret at six months.
- Rationale: Cochrane reviews show consistent benefits; the implementation literature shows that aids used only when clinicians remember them are rarely used at all.
- Proposed test: A stepped-wedge rollout across eight breast and prostate services measuring use, decisional conflict, treatment choices, and regret.
- Maturity: early-clinical
- Actor: clinic

## Sources

- Bottleneck evidence (Fragmented care and guideline gaps): Hanna et al., Mortality due to cancer treatment delay: systematic review and meta-analysis (BMJ 2020): https://doi.org/10.1136/bmj.m4087

## Connected records

- cancers: [HR-positive / HER2-negative breast cancer](https://onco.cc/cancers/breast-hr-positive/), [Prostate cancer](https://onco.cc/cancers/prostate/)
- bottlenecks: [Fragmented care and guideline gaps](https://onco.cc/bottlenecks/b-care-fragmentation/), [Patients lack understanding, navigation and agency](https://onco.cc/bottlenecks/b-patient-voice/)
- key papers: [Mortality due to cancer treatment delay: systematic review and meta-analysis](https://onco.cc/key-papers/paper-hanna-bmj/), [USPSTF 2018: screening for prostate cancer, recommendation statement (grade C at 55 to 69, grade D at 70 and over)](https://onco.cc/key-papers/paper-uspstf-prostate-screening-jama-2018/)

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