Table 1 Description of steps included in the PDA

1

Introduction

A. Background information: Information about eligibility of TKI dose reduction, the purpose of dose reduction and a link to CML care platform CMyLife for detailed information about CML and its treatment.

B. Dose reduction: More detailed information is provided. Information is structured to answer the following questions: What does dose reduction entail? Do I have to choose dose reduction?

C. Results: Information is structured to answer the following questions: What happens to my CML? What is the effect of dose reduction on side effects? Is it possible to experience side effects from dose reduction?

D. Possibilities: Information is structured to answer the following questions: Is it still possible to switch from TKI in the future? Is a treatment free remission attempt still possible?

2

Differences and similarities

An overview of differences or similarities between dose reduction or not is given for the following topics: extra blood sampling, consequences for CML, effects on side effects, possibility to switch from TKI in the future, and possibility for a treatment free remission attempt in the future.

3

Knowledge check

Four statements about dose reduction with real-time feedback on the answers given are presented. Topics include effect on side effects, blood sampling, consequences of increased BCR-ABL1 levels, and consequences for a future treatment free remission attempt.

4

Evaluation and decision making

With a slider, patients are asked to what extent they agree/disagree with statements about side effects, extra blood sampling, importance of medication quantity, concerns about potential increased CML activity, and concerns regarding a potential treatment free remission attempt.

5

Expectations and concerns

With open and closed questions patients are asked about their concerns about dose reduction, what side effects they experience currently, if they understand enough about the (dis)advantages, if they know what pros and cons are most important to them, and they are asked to specify information they want from their healthcare provider. Finally, patients are asked what treatment option they prefer.

6

Summary

A summary sheet consisting of the patient’s personal considerations, preferences, and questions for the healthcare provider. The sheet can be printed, saved as PDF and emailed.