{"entity":{"id":"idea-moon-certified-decision-aids","kind":"idea","name":"Certified decision aids required for every preference-sensitive cancer decision","aka":[],"tldr":"For choices where the right answer depends on what the patient values (watching a slow prostate cancer, adjuvant chemo at 80, breast reconstruction), a tested decision aid becomes part of the consultation.","summary":"Decision aids improve knowledge, accuracy of risk perception and value-concordant choices in Cochrane reviews, yet are rarely used. The proposal is that guideline bodies designate a list of preference-sensitive decisions, that decision aids meeting IPDAS standards are certified for each, and that use is documented and audited like consent. A shared decision quality metric (knowledge plus concordance between stated values and chosen option) becomes a quality indicator.","asOf":"2026-09-08","links":[{"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":[],"related":[],"cancers":["prostate","breast-hr-positive"],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":["b-patient-voice","b-overdiagnosis"],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"hypothesis":"Mandated certified aids raise decision quality scores, cut decisional regret at one year, and shift choices towards less intensive options in low-risk disease without worsening outcomes.","rationale":"In the absence of aids, choices track the clinician's habits and the local supply of services more than patient values, which is one mechanism of overtreatment.","test":"Cluster-randomised implementation trial for three decisions (low-risk prostate cancer, DCIS, adjuvant chemotherapy in patients over 75) measuring decision quality, regret and treatment mix.","maturity":"early-clinical","actor":"clinic","cost":"medium","horizonYears":3},"route":"/ideas/idea-moon-certified-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-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/"}]}}