15250-m-cuypers

93 PCPCC study protocol 5 treatment ( ‘I am confident enough that I will be treated on time, if necessary’ versus ‘ I do not want to postpone treatment because I do not want to be too late’ ), avoiding possibly unnecessary treatment (‘ If treatment might be unnecessary, I would rather wait ’ versus ‘ I prefer treatment, even if it might be unnecessary ’) and the acceptance of treatment side effects ( ‘I find possible treatment side effects like erectile and urinary dysfunctions difficult to accept’ versus ‘ I find the possible treatment side effects acceptable’ ). Each statement is related to one of the two offered treatment alternatives in this step. On a slider scale, patients can indicate for each set of statements the strength of their preference towards one of the alternatives. Following the same structure, the next step supports the consideration between surgery and radiotherapy. For surgery, three common methods are discussed (laparoscopic, open and robot assisted). For radiotherapy this consists of brachytherapy and EBRT. Again, information provision is followed by values clarification statements. The VCMs in this step emphasize the main differences between surgery and radiation therapy (both brachy and EBRT) in terms of treatment procedure (‘ I find it important that all cancer cells are removed from my body versus I find it important that the cancer cells die and not grow further ‘), side effects (‘ I find bowel problems worse than incontinence ’ versus ‘ I find incontinence worse than bowel problems’ ), secondary treatment ( ‘I am comforted by the thought that I can have radiation if surgery is unsuccessful’ versus ‘ I accept that surgery is difficult after radiation’ ) and fear for surgery ( ‘I am not anxious about surgery’ versus ‘I am anxious about surgery’ ). If a patient already indicated a preference for active surveillance in the previous step, the program allows patients to ignore this part and continue to the last step. As a conclusion, the final step asks patients to indicate their final treatment preference and briefly explain their choice. The DA does not provide a treatment advice, but helps the patient to reach an informed preference. A summary then provides an overview of all answers to the statements and the patients’ final preference. To discuss this summary with their urologist, the summary can be printed or accessed online during the next consultation. All statements used in the VCMs were developed by a team of urologists, psychologists and engineers based on previous experience and observation of conversations where treatment decisions were discussed. The statements were evaluated during usability- testing among patients, urologists and nurses (N=10). Recruitment Patients in both arms will be recruited by their treating urologist. When meeting the inclusion criteria, the urologist will use a letter and leaflet, in which the study is clarified, to invite eligible patients to participate. The letter and accompanying leaflet about the