15250-m-cuypers

18 Chapter 1 To investigate DA efficacy in a real world context, and to enable a thorough implementation analysis, the pragmatic cluster randomized trial reported in this dissertation was set up according to a hybrid effectiveness-implementation design, where simultaneous to testing the intervention, data was gathered on implementation 69 . In sum, the value of this dissertation lies in the pragmatic approach to contribute to the limited knowledge on implementing DAs in routine practice, while still being able to test the DA in a solid manner. AIMS AND ORGANIZATION OF THIS DISSERTATION The main objectives of the studies presented in this dissertation were: • To assess the current state of information provision, and the impact of diagnosis and treatment decision-making in Pca care on patient-reported outcomes; • To develop an online Dutch DA with values clarification exercises to support Pca treatment decision-making; • To assess the impact of this online treatment DA on patient-reported outcomes and care providers’ evaluations; • To analyze implementation results of the current DA and two other novel Dutch Pca treatment DAs. SDM requires an active patient role, and DAs can help patients in achieving such a role. The aim of Chapter 2 was to investigate in a sample of Pca patients who already made a treatment decision in the past (average 48 months ago), what role preference they have, and how this role preference was associated with their satisfaction with the information that was received at the time of decision-making. To more closely investigate the impact of receiving a Pca diagnosis and the subsequent decision-making process, Chapter 3 describes the changes in health-related quality of life (HRQoL) in the time between undergoing biopsy (pre-diagnosis) and making a decision about treatment in case Pca was detected. Furthermore, it was assessed if personality traits were associated with changes in HRQoL. The development and pilot-testing of the DA that was developed is described in Chapter 4 . The rationale and study design of the pragmatic, cluster randomized Prostate Cancer Patient Centered Care (PCPCC) trial are presented in Chapter 5 . The aim of the PCPCC trial was to assess the impact of the DA on patient-reported outcomes, and care providers’ opinions. Furthermore, uptake of the DA across hospital sites was studied.