Abstract
Uptake of decision aids (DAs) in daily routine is low, resulting in limited knowledge about successful DA implementation at a large scale. We assessed implementation rates after multi-regional implementation of three different prostate cancer (PCa) treatment DAs and patient-perceived barriers and facilitators to use a DA. Thirty-three hospitals implemented one out of the three DAs in routine care. Implementation rates for each DA were calculated per hospital. After deciding about PCa treatment, patients (n = 1033) completed a survey on pre-formulated barriers and facilitators to use a DA. Overall DA implementation was 40%. For each DA alike, implementation within hospitals varied from incidental (< 10% of eligible patients receiving a DA) to high rates of implementation (> 80%). All three DAs were evaluated positively by patients, although concise and paper DAs yielded higher satisfaction scores compared with an elaborate online DA. Patients were most satisfied when they received the DA within a week after diagnosis. Pre-formulated barriers to DA usage were experienced by less than 10% of the patients, and most patients confirmed the facilitators. Many patients received a DA during treatment counseling, although a wide variation in uptake across hospitals was observed for each DA. Most patients were satisfied with the DA they received. Sustained implementation of DAs in clinical routine requires further encouragement and attention.
Highlights
Prostate cancer (Pca) is the most common malignancy diagnosed in men in the western world
Most Decision aids (DAs) trials, including those related to Pca treatment, focused on determining the DA effects, with limited attention for implementation aspects [7, 9]
With the current implementation study, we aimed to investigate the implementation rate of these three DAs in routine Pca care in The Netherlands, and aimed to identify possible barriers and facilitators from the patients’ perspective
Summary
Prostate cancer (Pca) is the most common malignancy diagnosed in men in the western world. In the case of localized prostate cancer, patients are typically required to choose between multiple equivalent treatment options. Clinical guidelines concerning localized Pca suggest a shared patient-doctor decision to incorporate patient preferences and values into the treatment decision [2,3,4,5]. Decision aids (DAs) have been developed to assist patients and care providers with shared decision-making (SDM) [6]. Evidence for the beneficial effects of applying DAs is widely available and shows that patients have better knowledge of the treatment options, and are more aware of their personal preferences and values [7]. Most DA trials, including those related to Pca treatment, focused on determining the DA effects, with limited attention for implementation aspects [7, 9]. Uptake of DAs in daily routine, outside of clinical trials, is low, resulting in limited knowledge about successful DA implementation at a large scale [7, 12,13,14,15,16]
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