gms | German Medical Science

Background: Many cancer patients want active engagement in treatment decision-making. Despite evidence, shared decision making (SDM) is not widely implemented in routine practice. Programs which encourage patients to ask questions during a clinical encounter can strengthen their abilities to engage in the decision-making process. The Ask Three Questions program was developed and evaluated in Australia. Different versions of the program were used in implementation programs around the globe. So far, the program is not available in German.

Aims: The aims of this study were to develop a German version of the program and to assess its feasibility in German routine care.

Methods: First, different English versions of the Ask 3 Questions program used in prior studies were translated into German. The translation process followed recommendations from the team translation protocol TRAPD (Translation, Review, Adjudication, Pretesting and Documentation). Second, comprehension of the translation was tested via cognitive interviews with patients (n=10). Health literacy was assessed with the HLS-EQ-16. Two members of the research team discussed the results of qualitative analysis of the interviews and found a consensus version. In case of disagreement, results were discussed with a third team member. Third, feasibility of the German version will be assessed in focus groups with patients and clinicians.

Preliminary results: Patients of different age (49.0 years ± 11.27), gender (f=5, m=5), years with disease (4.8 years ± 3.55), and different health literacy levels took part in cognitive interviews. Comparison and testing of different versions of the three questions led to a revised version, which was understood and accepted best by German patients. All participants found the Ask 3 Questions program helpful for use as posters or flyers in waiting rooms. Results of the feasibility assessment will be presented at the conference.

Discussion: This study provides a German version of the Ask 3 Questions program to be used in Germany for the first time. Preliminary results suggest that the Ask 3 Questions program could be a helpful instrument to empower patients in Germany to play an active role in the decision-making process.

Practice implications: To implement SDM in routine cancer care and to increase the involvement of patients in the SDM-process, specific programs are needed. The Ask 3 Questions program is a well-established and widely used implementation program. The German version of the program, consisting of posters and flyers, could be used in various medical facilities, where patients have to make decisions regarding their health care. In following steps of this study, effects on SDM adoption will be measured by audio-recording clinical consultations before and after the implementation of the Ask 3 Questions program. They will be analyzed by

1.

counting the use of the three questions, and

2.

measuring adoption of SDM using the OPTION5 scale.