{"entity":{"id":"idea-acc-embedded-decision-aids","kind":"idea","name":"Decision aids built into the record for every preference-sensitive cancer choice","aka":[],"tldr":"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.","asOf":"2026-09-08","links":[{"label":"Stacey et al., Decision aids for people facing health treatment or screening decisions (Cochrane Database Syst Rev 2024)","url":"https://doi.org/10.1002/14651858.CD001431.pub6"},{"label":"NICE NG197: Shared decision making, recommendations","url":"https://www.nice.org.uk/guidance/ng197/chapter/Recommendations"},{"label":"Bottleneck evidence (Fragmented care and guideline gaps): Hanna et al., Mortality due to cancer treatment delay: systematic review and meta-analysis (BMJ 2020)","url":"https://doi.org/10.1136/bmj.m4087"},{"label":"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)","url":"https://doi.org/10.1001/jama.2017.7156"}],"tags":["protocol-upgrade","upgrade:proven-unevenly-used","evidence:strong"],"related":[],"cancers":["breast-hr-positive","prostate"],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":["b-care-fragmentation","b-patient-voice","b-overdiagnosis"],"keyPapers":["paper-hanna-bmj"],"journals":[],"dependsOn":[],"notes":["Protocol upgrade, graded proven but unevenly used. The 2024 Cochrane review of 209 randomised trials with 107,698 participants found high-certainty evidence that patient decision aids improve knowledge (mean difference 11.90 on a 100-point scale) and accuracy of risk perception (risk ratio 1.94), and moderate-certainty evidence that they increase agreement between people's informed values and their choices (risk ratio 1.75). NICE's 2021 shared decision making guideline (NG197) includes a section on patient decision aids. How often decision aids are used in cancer care has not been measured."],"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.","test":"A stepped-wedge rollout across eight breast and prostate services measuring use, decisional conflict, treatment choices, and regret.","maturity":"early-clinical","actor":"clinic","cost":"small","horizonYears":2},"route":"/ideas/idea-acc-embedded-decision-aids/","neighbours":{"cancer":[{"id":"breast-hr-positive","kind":"cancer","name":"HR-positive / HER2-negative breast cancer","route":"/cancers/breast-hr-positive/"},{"id":"prostate","kind":"cancer","name":"Prostate cancer","route":"/cancers/prostate/"}],"bottleneck":[{"id":"b-care-fragmentation","kind":"bottleneck","name":"Fragmented care and guideline gaps","route":"/bottlenecks/b-care-fragmentation/"},{"id":"b-overdiagnosis","kind":"bottleneck","name":"Overdiagnosis and false alarms","route":"/bottlenecks/b-overdiagnosis/"},{"id":"b-patient-voice","kind":"bottleneck","name":"Patients lack understanding, navigation and agency","route":"/bottlenecks/b-patient-voice/"}],"paper":[{"id":"paper-hanna-bmj","kind":"paper","name":"Mortality due to cancer treatment delay: systematic review and meta-analysis","route":"/key-papers/paper-hanna-bmj/"},{"id":"paper-uspstf-prostate-screening-jama-2018","kind":"paper","name":"USPSTF 2018: screening for prostate cancer, recommendation statement (grade C at 55 to 69, grade D at 70 and over)","route":"/key-papers/paper-uspstf-prostate-screening-jama-2018/"}]}}