15250-m-cuypers

185 Decision aid uptake and usage in clinical practice 9 A limitation of the current study was that distribution of the DA was linked to trial participation measuring the DA’s effectiveness 17 . Next to introducing the DA, care providers also had to explain enrollment in the trial and had to obtain informed consent to have patients participate in the questionnaire study. Although patients were informed that the DA could also be used without participation in the trial, it could have served as a barrier for DA use for some patients. Also, determination of the total number of eligible patients was estimated based on the number of Pca patients registered in the Netherlands cancer registry in previous years (2009-2013). Regional trends (hospital mergers, changes in offered treatments) could potentially have caused some inaccuracy in the estimation of the number of patients during the trial per hospital. Nevertheless, as thesenumber are fairly stableover time it is unlikely that thiswouldhave a large influence on our findings. Moreover, the estimation was based on tumor stage only (cT1 and cT2), which could mean that the registry data included patients that would not have met the DA inclusion criteria due to comorbidities or other clinical characteristics. Therefore, the calculated degrees of implementation could underestimate actual implementation slightly. This, however, is likely to occur in all hospitals and could therefore contribute to a margin of error within the estimation that is equal for all hospitals and as such, is unlikely to explain variations in implementation rates observed across hospitals. Conclusion While many studies have provided evidence that DAs can be effective tools to support SDM in clinical practice, this study is one of the first to provide a detailed analysis of the implementation results and usage rates of a DA in clinical routine. Eight out of nine hospitals involved in this study succeeded to implement a novel Dutch web-based Pca treatment DA in clinical routine within the trial period. Uptake between these hospitals varied from incidental to structural and patients varied in the extent to which they utilized all DA components. Most patients expressed a treatment preference and used the DA summary to talk about values and preferences with their urologist. Based on our results, strategies to further improve DA adoption by care providers and patients can be targeted more specifically.