15250-m-cuypers

155 Care providers evaluation of DA and usual information 8 1. INTRODUCTION To increase shared decision-making (SDM) in clinical encounters, use of patient decision aids (DAs) is recommended 1-4 . DAs come in multiple formats and, in addition to regular consultation, help to explain options, clarify values for benefits and harms, and guide deliberation and communication 5 . Studies have shown that DAs can lead to increased choice awareness, more knowledge and reduced decisional conflict 6 . Some studies even suggest patients select less invasive treatments after consulting a DA 7 . Although DAs have been developed and are available for a wide variety of treatment and screening decisions, routine use in clinical care remains limited 8 . Clinician attitudes towards SDM and DAs are an important aspect when trying to promote DA uptake 9 10 . Barriers for applying SDM were identified in earlier studies and included time constraints and perceptions that the patients or the clinical situation were not suitable for applying SDM. Identified facilitators consisted of clinician motivation, positive impact on the clinical process and patient outcomes 11 . More specific research on DA implementation showed that the method of delivering DAs to patients often is an important barrier for routine DA use. Although evidence suggests a more systematic delivery approach (e.g. automated sending though a link with the electronic patient record) is more effective compared to a clinician initiated method, clear recommendations for optimal DA delivery to patients are not yet available 8 . A clinical area in high need for SDM, and therefore ideally suited for DA use, is prostate cancer treatment decision-making 12, 13 . Prostate cancer (Pca) is the most common cancer in men in the western world 14 . Depending on patient and tumor characteristics, Pca patients could be offered a choice between surgery, radiotherapy and active surveillance. Oncological outcomes of these options are considered to be equivalent, however, each option has a specific risk and side-effect profile 15-17 . Pca treatment guidelines do not indicate a single superior option but encourage SDM to select the alternative that fits best with the patients’ characteristics and preferences 18 . As SDM should include creating choice awareness, providing information about treatment harms and benefits, and preference elicitation, DAs are helpful tools to support this process. For application in Dutch clinical care, a novel web-based Pca treatment DA has been developed and a cluster randomized controlled trial (RCT) has been conducted to evaluate patient outcomes and implementation 19, 20 . To gain insight in underlying clinician motivations for the adoption of this DA in routine clinical care, we evaluated