Lessons Learned From Shared Decision-Making With OralAnticoagulants:Viewpoint on Suggestions for the Developmentof Oral Chemotherapy Decision Aids

Oral chemotherapy is commonly prescribed, and by using decision aids (DAs), clinicians can facilitate shared decision-making(SDM) to align treatment choices with patient goals and values. Although products exist commercially, little evidence informsthe development of DAs targeting the unique challenges of oral chemotherapy. To address this gap in the literature, our objectivewas to review DAs developed for oral anticoagulation, DA use in oncology, and patient preference surveys to guide the developmentof DAs for oral chemotherapy. We focused on reviewing SDM, patient preferences, and specifically the development, efficacy,and patient experience of DAs in oral anticoagulation and oncologic conditions, ultimately including conclusions and data from30 peer-reviewed publications in our viewpoint paper. We found that effective DAs in oral anticoagulation improved knowledge,lowered decisional conflict, increased adherence, and covered a broad range of SDM elements; however, limited information onpatient experience was a common shortcoming. In oncology, DAs increased knowledge and aligned decisions with the values ofthe patients. Ineffective oncology DAs provided general, unclear, or overly optimistic information, while providing "too much"information was not shown to do harm. Patients preferred DAs that included pros and cons, side effects, questions to ask, andexpected quality of life changes. In developing DAs for oral chemotherapy, patients should be included in the developmentprocess, and DA content should be specifically tailored to patient preferences. Providing DAs ahead of appointments provedmore effective than during, and additional considerations included addressing barriers to efficacy. There is a need for evidence-basedDAs to facilitate SDM for patients considering oral chemotherapy. Developers should use data from studies in oral anticoagulation,oncology, and preference surveys to optimize SDM.