# Certified decision aids required for every preference-sensitive cancer decision

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

## TL;DR

For choices where the right answer depends on what the patient values (watching a slow prostate cancer, adjuvant chemo at 80, breast reconstruction), a tested decision aid becomes part of the consultation.

## Summary

Decision aids improve knowledge, accuracy of risk perception and value-concordant choices in Cochrane reviews, yet are rarely used. The proposal is that guideline bodies designate a list of preference-sensitive decisions, that decision aids meeting IPDAS standards are certified for each, and that use is documented and audited like consent. A shared decision quality metric (knowledge plus concordance between stated values and chosen option) becomes a quality indicator.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: Mandated certified aids raise decision quality scores, cut decisional regret at one year, and shift choices towards less intensive options in low-risk disease without worsening outcomes.
- Rationale: In the absence of aids, choices track the clinician's habits and the local supply of services more than patient values, which is one mechanism of overtreatment.
- Proposed test: Cluster-randomised implementation trial for three decisions (low-risk prostate cancer, DCIS, adjuvant chemotherapy in patients over 75) measuring decision quality, regret and treatment mix.
- Maturity: early-clinical
- Actor: clinic

## Sources

- Bottleneck evidence (Patients lack understanding, navigation and agency): Basch et al., Overall survival results of a trial assessing patient-reported outcomes for symptom monitoring during routine cancer treatment (JAMA 2017): https://doi.org/10.1001/jama.2017.7156

## Connected records

- cancers: [HR-positive / HER2-negative breast cancer](https://onco.cc/cancers/breast-hr-positive/), [Prostate cancer](https://onco.cc/cancers/prostate/)
- bottlenecks: [Overdiagnosis and false alarms](https://onco.cc/bottlenecks/b-overdiagnosis/), [Patients lack understanding, navigation and agency](https://onco.cc/bottlenecks/b-patient-voice/)

---
JSON: https://onco.cc/api/v1/entities/idea-moon-certified-decision-aids.json