15250-m-cuypers

163 Care providers evaluation of DA and usual information 8 Models on successful implementation of health innovations emphasize the facilitating role of positive patient outcomes 11, 21, 25 . The intended goal of DAs is to increase knowledge, help clarify personal values and to help patient take a more active role in the process of treatment selection 5 . For the particular DA used in this study, it was already found that treatment choices made with the DA were more often in line with the patient’s preferences compared to preferred option by the clinician 26 . Nevertheless, this study indicates that healthcare providers from both groups did not have strong experiences or expectations about patient outcomes after DA use. Health care providers answered items related to these aspects most often around the scale midpoints. This could indicate two potential barriers for DA implementation; first, care providers could be insufficiently aware of patients outcomes associated with DA use, and secondly, patient outcomes could be insufficiently observable by care providers at the moment of treatment decision making. To revolve both issues, care providers should be made more aware of the potential benefits associated with DA use. Once implemented, care providers could be motivated to continue DA distribution by receiving structural feedback on DA usage rates and patient outcomes (e.g. knowledge, satisfaction with decision, and regret). This should also take into account that effects may emerge long after the decision was made (e.g., one year post-decision), requiring long-term follow-ups 9, 27 . In contrast to earlier studies, this study showed that time constraints were not perceived by health care providers who worked with the DA nor expected by health care providers fromthe control arm 11,28 . Possibly, this is the result of the growing awareness and interest for SDM and DAs in recent years 29-31 . More awareness for DA use could have adjusted our respondents’ expectations about consultation length when using DAs. Moreover, three major clinical trials with different Pca treatment DAs have been conducted recently in The Netherlands, with involvement of almost half of all Dutch hospitals in one of these trials and thus increasing scientific and public attention for DA usage 20, 32, 33 . This may have contributed to our finding that time constraint is not considered a barrier for DA use in Dutch Pca care. It has to be noted that care paths in Dutch Pca care already allow for multiple contact moments needed to facilitate SDM and DA use (e.g. choice talk, option talk, decision talk), whereas for DA use in other diseases or conditions some of these moments need to be added 34 . We found that the number of patients who received a DA variedwidely between hospital sites. Themajority of respondents in this study indicatedwhen a DAwas not offered to an eligible patient, this was because it was forgotten or the clinician estimated the patient was not suited or willing to use a DA which could potentially be a misinterpretation