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210 Chapter 11 treatment and the information received. Main effects from the DA on these outcomes were not found. A less favorable patient-doctor relation and anxiety and depression symptoms were associated with increased odds of reporting regret about the chosen treatment. In addition to positive patient evaluations, is commitment from care providers an important factor for sustained use of DAs in routine clinical practice. Previous studies showed that care providers’motivations are an important facilitator for implementation of DAs. In Chapter 8 we assessed care providers’evaluation of DA usage in the DA armof the PCPCC trial, and the evaluation of usual information routines among care providers from the control arm. From both trial arms, 108 care providers (urologists and nurses) were invited, and 63 filled out the questionnaire (response 58%). Care providers from the DA arm were supportive of the DA content and usability. Satisfaction with the DA was comparable to satisfaction with usual information among care providers from the control arm. However, care providers from the control arm did perceive that patients, with their usual information routines, already receive too much information. In contrast to earlier studies, care providers from both trial arms did not experience neither expect time barriers from DA use. Next to assessing outcomes reported by patients and care providers, the PCPCC trial aimed to measure the level of DA implementation in routine clinical care ( Chapter 9 ). The level of DA implementation within the PCPCC was determined per individual hospital by taking the number of DA users (based on DA log data) as proportion of the estimated total number of eligible Pca patients during the trial period, based on historical registry data. With 351 patients receiving a DA, the average achieved level of implementationwas 35%across all hospitals. Between hospitals, implementation varied from 16% to 84%. After receiving the link to the online DA, most patients (79%) accessed the DA. In the post-decision questionnaire, 79% of the patients indicated that the DA summary was discussed with their doctor. With being one of the first studies to provide such detailed implementation and usage data, these results indicate that most patients used the DA once received, and that care provider and organizational (hospitals) factors should require further investigation in order to improve implementation. The DA developed and tested within the PCPCC trial was one of three Dutch Pca treatment DAs that were simultaneously implemented in routine clinical care for newly diagnosed Pca patients in The Netherlands, within a collaboration of the Joint Implementation Prostate cancer Patient-centered care (JIPPA) consortium. These DAs varied in format, consisting of a ‘concise paper DA’ (i.e print booklet) , a ‘very concise paper or online DA’ (i.e presented in a diagram style with short explanations), and the