Table 2

Features of patient decision aids and design strategies to limit their complexity and improve users’ experience

FindingFeature or design strategy to limit issue
Unclear purpose/topic of the patient decision aid
  • Clear statements in larger fonts describing who the decision aid is aimed at, and what it aims to achieve.

  • Pictogram or images showing people using the patient decision aid to represent its purpose.

  • Personal story displaying the context of use, and purpose of the patient decision aid.

Irrelevance of patient decision aid to people with dementia
  • Recognising caregivers’ role in decision-making through explicit statements that the patient decision targets caregivers equally to patients.

Arduous read or unclear content
  • Systematic and frequent use of high-quality pictograms to illustrate text.

  • Glossary to define complex terminology.

  • Write out the text at a sixth grade reading level.

  • Removal of the references within the text; reference list included on the DBox website.

  • Use ‘priority’ instead of ‘preference’.

Missing information on the options
  • Detailed and comprehensive description of each option.

  • For the more complex options: propose personal stories displaying a person going through the option.

Missing information on the next steps to implement the selected option following decision-making
  • Contact section listing contacts, resources and available services to implement each of the option.

Missing topic-specific information, irrelevant content
  • Use a user-centred design process until information needs are met and all sections are perceived as relevant.

Quality of the evidence
  • Offer information on the quality of the evidence to those interested.

Challenge using the Likert rating scales in the values clarification exercise
  • Asking users to select a single preference in a checklist; avoid rating scales.

Proposing meaningful priorities in the values clarification exercise
  • Involve a panel of patient/caregiver partners at start of development with mandates to (1) propose a list of priorities to guide the literature review and (2) revise the wording of priorities extracted from the scientific evidence (further evaluation required).

Navigation challenges
  • When the patient decision aid comprises more than two options, use the values clarification exercise to streamline navigation by inviting users to read more on the options meeting their priorities.

  • Use textual cues to refer to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) and to the glossary.

  • Use visual cues (eg, pictogram of the options) and colours to structure the general layout.

Irrelevance of scientific evidence to patients/caregivers
  • Explain the targeted shared decision-making behaviours in text and, if possible, with pictures.

  • Train patients/caregivers in shared decision-making to prepare them to review information on the benefits and harms of the options (further evaluation required).