Digital PDA Allows More Involvement in Treatment Decisions for Patients With Basal Cell Carcinoma

The development of a digital patient decision aid (PDA) for patients with superficial basal-cell carcinoma is described.

In light of recent studies demonstrating that patients with basal-cell carcinoma prefer being involved in the medical decision-making process, researchers developed a digital patient decision aid (PDA) for patients with superficial basal cell carcinoma (sBCC). In a research letter published in the British Journal of Dermatology, they detailed how patient and professional input improved the PDA; they also advocated for its implementation to determine if the PDA increases patient knowledge and decreases decisional conflict for sBCC patients.

In developing the PDA, Dutch investigators performed a literature review to provide content for inclusion in the tool. Effectiveness of standard sBCC treatment, treatment side effects and complications, cosmetic outcomes, difference in treatment regimens, and patient preferences and values were domains included in the PDA. A patient survey was administered to reveal the values patients considered important. Drafts of the PDA were evaluated by focus groups and analyzed then coded using a qualitative data software package, for incorporation into the PDA’s content.

During alpha-testing, 2 focus groups comprising patients and professionals evaluated drafts of the PDA and gave feedback on its content, graphics, and usability. The semi-structured patient focus group consisted of 8 patients – 3 men and 5 women – with a history of sBCC and a mean age 63.5 years (age range 50-77 years). The professional focus group consisted of 5 dermatologists with up to 14 years of experience.

Next, the PDA was evaluated by a project team of inpatient dermatologists, a dermatology resident, a physician assistant, an epidemiologist, a technical physician, patient representatives, a software developer, and a health technology assessment researcher.

Finally, investigators conducted patient interviews until sampling saturation, with 5 patients interviewed via phone or in-person. Patients assessed the PDA’s usability, workflow, and comprehensiveness using a think-aloud method. The interviews addressed changes made during alpha-testing; only minor details or technical bugs in the PDA were altered.

“There is sufficient evidence that dermatology patients would like to be involved in decision making,” the investigators concluded. “Testing this PDA in patients with newly diagnosed sBCC is essential to evaluate if the PDA results in better knowledge, decreased decisional conflict, and more contentment with their decision.”


van Delft LCJ, Essers BAB, Nelemans PJ, Mosterd K, Kelleners-Smeets NWJ. Development of a patient decision aid for superficial basal-cell carcinoma. Br J Dermatol. 2020. doi:10.1111/bjd.19662