15250-m-cuypers

173 Decision aid uptake and usage in clinical practice 9 BACKGROUND When diagnosedwith localizedprostate cancer (Pca), patients can face a choice between multiple surgical and radiotherapy options, or decide not to be treated immediately by following an active surveillance (AS) protocol. In the absence of a generally superior treatment option, patient preferences should guide this treatment selection process 1-3 . When such a preference-sensitive health decision has to be made, a collaborative approach from both the patient and care provider is preferred to select the best suiting treatment 4 . In this process of shared decision-making (SDM) a doctor provides all relevant information about the disease, treatments and consequences, and the patient shares his preferences and concerns 5 . SDM can be initiated or enhanced with help from decision support tools, such as decision aids (DAs). DAs come in multiple formats (e.g. booklet, web-based), but all provide structured and balanced information about the disease, available treatments, and the risks and benefits associated with these treatments 4, 6 . Often, DAs also include values clarification exercises (VCEs) to elicit patient preferences 7 . Previous studies have shown that patients, after using a DA, have more knowledge, lower decisional conflict, and more accurate risk perceptions 8 . If VCEs are included, patients are also more likely to select a treatment that is consistent with their values 8 . While many trials have reported beneficial patient outcomes after the use of decision support tools, routine use of such tools in clinical care still is low 9 . Only a few examples are known of sustained DA use after their initial evaluation in a clinical trial 10, 11 . Studies that have evaluated DA implementation from a care providers’ perspective identified important barriers, such as limited confidence in the (content of the) tools, time pressure and concerns about disrupting work procedures 9, 12 . A common patient-reported barrier is the feeling of being unable to engage in SDM or to use a DA, rather than being unwilling to do so 13 . Recently, policy makers in The Netherlands adopted SDM and DAs in their effort to improve quality of care 14 . Funding programs are encouraging SDM and usage of DAs. As such, patient groups, professional bodies, health care insurers and hospitals are stimulated to implement DAs for multiple medical conditions, and DA developers are stimulated to develop new DAs 15 . Although much is known about attitudes, barriers and facilitators towards SDM and DAs, there is limited data available about actual achieved degrees of implementation and the precise proportion of patients using DAs once distributed. Often this is because the tool or patient population does not allow for detailed registration of the exact number of eligible patients, number of tools