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133 Regret and information satisfaction at one-year follow-up 7 BACKGROUND Prostate cancer is themost commonmalignancy inmen in theWesternworld (1, 2).When detected at an early (localized) stage, multiple curative treatments (surgery, external beam radiotherapy, brachy therapy) can be considered, or the disease can be managed by active surveillance (AS), with identical survival (3-5). The perceived burden of the treatment procedure and impact of side-effects can be different for individual patients (6-8). Reaching an optimal fit between patient and treatment is the most important goal in treatment counseling. However, many treatment decisions in Pca care tend to reflect the doctor’s preference instead of the patient preference (9-11). While involving patients in the treatement decision, providing adequate information, and discussing all options reduces the risk of patients regretting their decision (12-15). Decisional regret is defined as‘remorse or distress over a (health care) decision’(16). Up to a quarter of Pca patients are known to experience regret after choosing and undergoing treatment, which can persist up to 15 years after treatment (13, 17). In contrast to the expectation that treatment specific side-effects (e.g. incontinence after surgery) cause regret, most studies have not found differences across treatment modalities (11, 18-20). Inorder to involvepatients in thedecision-makingprocess andenablewell-informedand preference-concordant decisions, current Pca guidelines recommend a shared patient- doctor decision (21). The use of patient decision aids (DAs) is promoted to facilitate this process of shared decision making (SDM). DAs provide balanced information on all treatments, help clarify personal values, and guide patients to establish an informed treatment preference with realistic expectations (22, 23). Studies on the long term consequences (i.e. regret) of decisions made after DA interventions are less common. The latest Cochrane review on the effects of DAs included 7 out of 105 DA studies that reported on decision regret, of which none were in Pca patients (24). Only one of these 7 studies reported lower regret in DA users (25). Other studies that did focus on Pca patients found weak or no long-term DA effects on decision regret (26, 27). Feldman-Stewart and colleagues found beneficial effects from values clarification exercises (VCEs) included in a Pca DA on regret at a one-year follow- up, while no differences were found 3-monthts post-decision, suggesting a positive DA effect can still emerge long after the decision is made (28). A novel Dutch web-based Pca treatment DA with VCEs has been developed and tested in a pragmatic, cluster randomized trial (29, 30). Evaluations directly after treatment choice showed that patients with the DA made different treatment choices compared