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19 General introduction 1 The patient-reported outcomes are presented in two parts. First, Chapter 6 presents effects of the DA on patient-reported decision process outcomes immediately after treatment decision-making, with decisional conflict as primary outcome measure, and knowledge and satisfaction as secondary outcomes. Satisfaction was assessed in terms of information satisfaction, and preparation for decision-making. Anxiety and depression symptoms were included as covariates, as they could potentially be affected by the DA, as well as have an effect on the other outcomes. Secondly, in Chapter 7, a 12-months follow-up is presented with the effects on decisional regret (primary), treatment satisfaction and information satisfaction (secondary) are presented. It was expected that undergoing treatment and experiencing potential side-effects could influence how patients in retrospect would evaluate the information that was received. Besides anxiety and depression, the patient-doctor relation was included as covariate. The aim of Chapter 8 was to compare care providers’ evaluations of DA counseling to standard information routines. Implementation and usage results of the DA are presented in Chapter 9. Next to the DA studied in the previous chapters of this dissertation, two other Pca DAs were developed and tested simultaneous in The Netherlands. In Chapter 10 , a joint evaluation of the implementation results is presented. In Chapter 11 , the main findings of this dissertation will be discussed, and the implications for future research and clinical practice are outlined. A schematic overview of how the topics in this dissertation are related is presented in Figure 4. OtherDutchPcaDA studies (JIPPA) PCPCC trialdesign (5) Outcomes immediatelyafter treatment selection (6) QoLchanges prior to treatment (3) 1-year follow-up (7) Care providersevaluation ofDA and other information routines (8) Preferreddecision-making roles and information satisfaction in retrospect (2) JIPPAevaluation (10) DA uptakeandusage (9) DA development (4) Patient Careprovider Pcadiagnosis (team talk) Choiceof treatment ( decision talk) Pca treatment Treatment counselingandDA (option talk) Shareddecisionmaking: Figure 4. Schematic overview of the topics in this dissertation (chapter)