15250-m-cuypers

176 Chapter 9 participating hospitals allowed the NCR to provide us with data about their number of patients diagnosed, except for one. From these registry data, an estimation was made on the expected number of eligible Pca patients during the trial period. Eligibility was defined as being diagnosed with low or intermediate risk Pca (PSA level below 20 and a maximum Gleason score of 7) 18 . Additionally, patients were required to have access to the Internet and to be able to read and understand Dutch language. An online questionnaire to evaluate DA usage by patients, was sent (paper version on request) to patients after the treatment decision was made. The questionnaire included items about when the DA was received and from who (urologist or nurse), whether the DA was sufficiently explained, and whether the DA summary was discussed during a subsequent consultation. Data analysis The degree of implementation was calculated by dividing the number of DAs provided to patients (based on access cards distributed by care providers) by the estimated total number of eligible Pca patients (based on national registry data) per hospital. Descriptive statistics were presented as means (and SDs) for continuous variables and frequencies (and percentages) for categorical variables. Group comparisons between DA users and non-DA users and between questionnaire responders and non-responders were made with t -tests for continuous variables and chi-square tests for categorical data. Statistical analyses were conducted using SPSS 22.0 (Statistical Package for Social Sciences, Chicago, IL). Tests were considered statistically significant if p <.05. RESULTS From national registry data, it was estimated that during the trial period, 1,006 patients were diagnosedwith localized Pca in participating hospitals.With 351 DAs distributed to patients, the average achieved degree of implementation across all study locations was 35%, varying between 16% and 84% across hospitals. Highest implementation levels (84 and 79%) were achieved in hospitals who were also involved in DA development. Implementation did not succeed in one hospital due to a lack of organizational support (also no registry data were obtained for this hospital), this hospital was therefore excluded from further analyses. Detailed implementation results across all participating hospitals is presented in Table 1.