OnCo
ideasIdea

Certified decision aids required for every preference-sensitive cancer decision

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.

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.

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.
What would test it
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
Who has to act
clinic
Cost to try
Medium ($1M to $50M)
Years to first evidence
3
Bottlenecks it attacks

Connected

4top

Pages like this

not linked directly; found by shared links

cancers

2
HR-positive / HER2-negative breast cancerProstate cancer

bottlenecks

2
Overdiagnosis and false alarmsPatients lack understanding, navigation and agency