Aim: One-third of cancer patients experience anxiety and depression. Despite availability of effective treatments, uptake of psycho-oncology referral is low. Patient decision aids (PDAs) are evidence-based resources to support informed decision-making. This study aimed to (1) develop a PDA for cancer patients with anxiety and/or depression and (2) explore patient perceptions of the PDA acceptability, and usability
Methods: PDA development was based on International Patient Decision Aid Standards and the Ottawa Decision Support Framework and used an iterative approach. Stage 1: PDA content was developed based on psycho-oncology literature, clinical guidelines and the ADAPT Anxiety and Depression Clinical Pathway. Stage 2: An expert panel of psycho-oncology clinicians was established to review content; feedback was incorporated, and revisions presented to clinicians to gain consensus. Stage 3: Cancer patients/survivors participated in cognitive interviews using ‘think aloud’ methodology and semi-structured interviews to explore overall acceptability, clarity, ease of use, and perceived usefulness of the PDA
Results: Our expert stakeholder panel (n = 5) confirmed overall clinical accuracy and suggested only minor changes to medication side effect information. Twenty one patients /survivors participated in cognitive interviews to review the PDA. 52.4% had previously and 38% currently accessing anxiety/depression treatment. Thematic analysis identified four themes (1) filling a gap: usefulness of information (2) ease of use (3) missing the ‘decision’ in decision aid: misunderstandings of purpose (4) supporting decision-making. Feedback from interviews resulted in minor changes to the values clarification exercise format.
Conclusion: Clinicians perceived the PDA to be clinically accurate, easy to understand, and potentially useful in clinical practice. Patients/Survivors reported high levels of acceptability and comprehensibility. The patient decision aid was perceived as easy to use. Eliciting patient treatment preferences is the cornerstone of informed decision-making. This PDA will assist patients to make values concordant anxiety and depression treatment decisions.