Table 1.

Key components of a decision aid for adults with cancer

DecisionKEYS for balancing choices: cancer care
Component	Content Elements	Process
Social support	Because patients generally do not make decisions in isolation, each patient is asked to choose a supporter (defined as any family member or concerned other who consistently provides emotional support) to accompany the patient to the clinic visits and participate in the decision process with the patient.	Ongoing inclusion of a support person throughout the process if available.
Anticipatory guidance related to the disease and treatment	Includes standard/usual care at the site (e.g., what to do about treatment side effects, signs of an infection, how quality of life is measured, why a treatment would be changed or stopped) using the clinics’ existing patient education pamphlets, such as those developed by the National Cancer Institute or Cancer Care National Office.	Content elements have been reviewed by a panel of experts for each type of cancer of interest. The brochures are helpful, but not the primary source of information, which rests with the physician.
A brief quality decision making process tutorial	Teaches parts of a psychological theory in the form of a “Decision Making Guide” (a synopsis of the Janis & Mann’s decisional conflict theory), to provide understanding of “why” quality decision making is important and how it affects satisfaction/regret of a consequential decision. The decision theory has been simplified into an easy-recall method by Hollen using a linear graphic diagram.	Handout with graphic depicting the theory is used at clinic visit and then provided to the patient/supporter pair to also review at home.
Patient’s decision participation preference	Determines the patient’s preference for level of participation in treatment decision-making, and shares this preference with the physician as a part of each decision within the intervention.	Control Preference Scale is used at each decision as preference may change over time.
Normalization	Provides the context of what others in similar situations have done, using the “Cancer Survival Toolbox: An Audio Resource Program” (latest edition) [© 2007; National Coalition for Cancer Survivorship, Oncology Nursing Society, Association of Oncology Social Work, and Genentech BioOncology]. The program includes a basic skills set of six topics: (1) Communicating; (2) Finding Information; (3) Making Decisions; (4) Solving Problems; (5) Negotiating; and (6) Standing Up for Your Rights. To ensure a practical intervention, the overview is used.	CD Toolkit and CD player are in CD Home Kit for the patient/CPP dyad to keep for their own. Each dyad is shown how to use the CD player and a checklist is provided that outlines the three CDs for the program and amount of time needed to listen to each one.
Values clarification and preference discussion with several difficult decisions during treatment	Uses a decision balance sheet (a summary report for values/concerns/conflict designed by Janis and Mann) to weigh in terms of the benefits and risks for oneself and others, resulting in values clarification for the patient and care provider. The balance sheet exercise involves completion of a four-cell table related to the pros and cons for self and others, which was reviewed by two panels of experts (decision making and type of cancer). The final entry is the decision preference.	A balance sheet for the consequential decision is used in an interactive process at the clinic visit.
Structured time with oncology professionals to discuss difficult decisions	To enhance decision making to an informed, shared decision-making process, additional time is needed with the oncology professionals (at least 15–30 minutes of additional time with the oncology nurse at each decision time point, and 5 min of additional structured time with the oncologist).	Physician presents initial treatment choices to the patient (pair); nurse helps the patient (pair) process the information using the decision balance sheet; physician then uses information from the nurse to enhance the decision making process and answer further questions; physician then assures that the treatment decision is acceptable to the patient (pair).

Ref: Hollen et al., 2013, Support Care Cancer, p. 893