15250-m-cuypers

143 Regret and information satisfaction at one-year follow-up 7 patients with active treatment were likely to have completed treatment, and patients who underwent surgery had more time to adjust, which may have resulted in similar regret levels between trial arms at T3. Information satisfaction Information satisfaction in theDAarmwas statistically significantly lower atT1 compared to thecontrol arm. At later timepoints, thisdifference in informationsatisfactionbetween trial arms disappeared. With the DA, information about all treatments was provided, with equal attention to the benefits and riks of each treatment. This also implied explicitly presenting unpleasant information about possible adverse treatment effects (e.g. risks, side-effects, procedures) (30). Being exposed to unpleasant information, and becoming aware that there are downsides to all treatments, could have led to lower information satisfaction in the DA group compared to the control group at T1 (47, 48). Without the DA, care providers in the control arm were able to be more implicit about risks and could adjust counseling to the level of distress in the patient. Finding similar information satisfaction scores in both arms at follow-up could indicate that eventually patients were equally satisfied with each approach. DA implementation The overall conclusion of little regret and high satisfaction with both treatment and information, regardless of exposure to the DA may indicate that high quality care was received by most patients in this trial. By implementing the DA we aimed to improve quality of care and stimulate SDM between patients and care providers. However, execution of SDM involves more than distribution of a DA (49). In The Netherlands, uptake of SDM in clinical routine, including Pca care, is increasing (50). An example is the opportunity to visit both a urologist and a radiation oncologist to discuss treatment options from both viewpoints. In both trials arms most patients perceived a shared or patient-driven decision, and treatment satisfaction showed a ceiling effect. In this context, the potential beneficial effects from the DA could have been too small to be picked up within the broad regret and satisfaction measures of this study. This study found that anxious and depressive symptoms and the perceived patient doctor-relation were the most relevant factors affecting regret and satisfaction at follow-up. In order to optimally utilize the possibilities to manage anxious and depressive symptoms and support the patient-doctor relation with a DA, future research should look into the best moment to introduce and use the DA. The current DA was provided to all patients directly after diagnosis and presentation of the treatment options (29). Possibly, patients with anxious and depressive symptoms require more counseling from a nurse at this stage, before new information is presented with the DA (51-53). An earlier study found a