15250-m-cuypers

142 Chapter 7 In the multivariable logistic regression model (Table 3), receipt of the DA was not significantly associated with lower odds of reporting regret (OR 0.94, 95% CI 0.46- 1.93) or dissatisfaction with information (OR 1.02, 95% CI 0.52-2.00) after 12 months. Participants who reported anxious or depressive symptoms or a less favorable patient- doctor relation were more likely to report regret and dissatisfaction with information at follow-up. DISCUSSION This study longitudinally assessed regret, as well as patient satisfaction with treatment and information received, in a sample of Pca patients who chose treatment with or without receiving an online treatment DA. Results showed that at 12-months follow- up, the DA did not significantly impact any of these outcomes. Anxious and depressive symptoms and the perceived patient-doctor relation were associated with the odds of reporting regret and information satisfaction at follow-up. DA effects In our study only a few men (19%) regretted their treatment one year after they made the treatment decision. This confirms previous findings in similar populations, and measured with the same scale and follow-up time (18, 24). However, in contrast to Feldman-Stewart’s finding of late VCE effects (28), we did not find an effect on regret from the DA, which included VCEs, twelve months post-decision. This does not mean that the current DA or its VCEs had no effect during counseling. Patients with a DA chose different treatments compared to patients from the control condition. And as established earlier, treatment choices with the DA were more consistent with patient preferences instead of clinician preferences, while an opposite pattern is common in routine care without a DA (9, 31). With this effect established, the DA can potentially contribute to reduce unwarranted regional variations in Pca treatments (45, 46). Decisional regret Although no statistically significant difference in regret between trials arms was observed, a significant decline in regret within the DA arm appeared betweenT2 andT3. A possible explanation could be found in the larger proportion of patients who chose surgery in the DA arm. As Pca surgery has the shortest treatment time, at T2, a larger proportion of men in the DA arm was likely to have completed treatment, compared to patients from the control arm. However, surgery is also associated with severe adverse treatment effects, in particular in the first months after surgery (12, 13, 18). At T3 most