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Decision aids are too difficult for patients

Presented by
Dr Florine Schlatmann and Dr Michael van Balken, Rijnstate Hospital Arnhem, the Netherlands
EAU 2019
An elegant study by Dr Florine Schlatmann and Dr Michael van Balken (Rijnstate Hospital Arnhem, the Netherlands) studied all available Dutch shared decision-making tools for urological patients and analysed them for complexity. Their conclusion was that almost none of the patients understood the decision aids given to them.

Asking the challenging question, “How do we involve our patients and do they understand what we are saying?”, the researchers took all Dutch decision aids that are available for urological patients and looked at the quality of their clearness in informing patients. There were 13 decision aids in total, of which 4 had an Easy Read quality mark supposedly ensuring patient-friendly language. The texts were analysed, validated with software, and then scored for complexity; level 1 being the easiest (travel blog level) to level 4 being the hardest (scholarly article level). The difficulty of most of these aids landed between level 2 and 3. Their data showed that university-educated people could understand about 80% of aids that scored a 1; whereas people with a lower level of education only understood about 50%. In a decision aid scoring a 4, fewer than 10% of the text was comprehensible to people with an average education. The overwhelming conclusion was that most decision aids in the Netherlands are too difficult to understand for most of our patients, and extrapolating, this may even be a bigger problem in other countries.

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