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Patient involvement is receiving increased attention from the healthcare system, decision-makers, clinicians and patients. One way of increasing the patient involvement is through the concept of Shared Decision Making (SDM), which is a collaborative process allowing patients and healthcare professionals to make decisions together taking into account the best scientific evidence as well as patients’ values, preferences, life situation, and knowledge about disease process and prognosis.

Patient decision aids (PtDAs) are tools designed to assist caregivers in the process of informing patients about relevant treatment options. PtDAs contain factual and balanced information about the options and the pertaining pros, cons and probabilities. The tools can be digital, paper-based, videos, etc. and are often designed to a specific situation.

We present the process of developing a printed PtDA to assist in the choice of high (66 Gy in 3 fractions) or lower (45 Gy in 3 fractions) dose of SBRT for a tumor in the lung located adjacent (< 1 cm) to the thoracic wall. When treating tumors in this location with radiation therapy, there is an increased risk of causing chest wall pain or rib fractures in the patient. For this reason, reduction of the dose is common at the discretion of the physician, without asking for the patient’s preference. We want to involve the patients in this decision by using the PtDA.

The Regional Center for SDM at Vejle Hospital has developed a generic PtDA template in print, which forms the basis for our PtDA. The template consists of a frame that forms the setting for the decision that is to be made. Placed inside the frame is then different cards showing pros and cons for the different options, the timeline for the course and statistics.

During the spring of 2021, drafts for the paper cards showing the different dose levels, the timeline and statistics on the risk of side effects and expected local control were produced. We conducted a half-day workshop with both patients, relatives, physicians and RTT’s in May 2021. Drafts received comments and suggestions for improvement, statistics was altered to be easier to understand and patient stories were collected during the day. In particular, the direct input from patients helped improve the PtDA.

The result of this process was the second draft, which was then subjected to an alpha-test with four individual physicians, where the design and wording of the PtDA was further refined.

During the process there was a tight collaboration with a consultant at the Center for SDM, who also made comments about the design before the workshop was held.

Example of card with statistics

The final PtDA consists of a frame and 12 sheets and will be demonstrated at the conference. The PtDA will serve as the intervention in an upcoming RCT.