15250-m-cuypers

16 Chapter 1 DA effects A Cochrane review of the effects of DAs for various medical and screening decisions, including 105 RCTs, reveals that with a DA, patients are more knowledgeable, have more accurate expectations, and are more aware of what matters most to them 10 . In terms of quality of care, DAs help doctors and patients to talk more about really matters; not only what is medically possible, but also which goals the patient would like to achieve with treatment. In this way, a DA helps to lower decisional conflict, and establish a more valued patient-doctor relation. Increased satisfaction is often found for satisfaction with the choice, and the process of decision-making, including the preparation. However, satisfaction with the DA or overall information satisfaction has been studied less. Long- term studies into effects on regret are also rare. Overall, exposing patients to DAs does not seem to lead to adverse reactions, such as increased anxiety levels 10 . Implementation Although many studies found beneficial DA effects, uptake of DAs in routine clinical care is still low, and existing Pca specific DAs vary in quality 10, 55, 58, 59 . Research on implementation of DAs in routine clinical practice, including Pca care, is also scarce 60 . Consequently, much of the current DA results are obtained within the setting of RCTs, which limit the external validity of these findings for daily routine practice 61, 62 . Moreover, many DA studies were single center studies, with small samples 10 . This supports the need for a more pragmatic approach with multiple study sites, to enhance structural implementation and gain a better understanding of the effects of decision aids in regular, everyday clinical practice. The research and implementation project described in this dissertation has been designed with those aims in mind, as described in more detail below. Studies that did report DA implementation results have mostly been limited by a focus on the number of distributed DAs only 45, 63 . The relative reach within the patient population, or actual usage of the tool is therefore often unknown 45, 64 . Web-based DA dissemination provide opportunities to track usage, but usage can often not be linked to patient-reported outcomes (e.g. decision conflict, or DA evaluation). The studies reported in this dissertation aimed to provide a more structured approach to the evaluation of implementation by reporting about (1) reach within the eligible patient sample per hospital, about (2) actual usage in terms of usage of the different DA elements, and (3) linkage of usage to patient-reported outcomes and DA evaluations.