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Abstract

Background. Developing patient decision aids (PtDAs) requires considerable resources. We aimed to create a digital platform to streamline the process and investigate stakeholder perceptions of factors influencing the adoption of a mock-up of the platform. Methods. Using the Framework for Innovation, a design team developed an alpha version of the platform, with support from an advisory panel. A convenience sample of key stakeholders involved in the development of PtDAs, who were fluent in English, French, or Spanish, reviewed the mock-up in think-aloud sessions and answered open-ended questions structured along Normalization Process Theory constructs: Coherence, Cognitive Participation, Collective Action, and Reflective Monitoring. A thematic qualitative analysis was conducted by 3 researchers, iteratively improving the mock-up until no major issues emerged. Results. We recruited 20 participants, mainly women (n = 11), from 4 continents, including clinician–researchers (n = 15), patients (n = 4), and a health care manager (n = 1). Their experience in developing PtDAs ranged from none (n = 2) to more than 10 PtDAs (n = 1), with most having developed 2 to 5 PtDAs (n = 9). Participants noted that the platform could enhance the shared understanding of processes and roles (Coherence), support input from different stakeholders (Cognitive Participation), and streamline development and revision, recommending features such as version tracking (Collective Action). They also emphasized the need for customizable PtDA templates, training, and PtDA certification (Reflective Monitoring). Limitations. Few participants were from middle- or low-income countries, limiting the findings’ transferability to these populations. Conclusions. Next steps include developing and evaluating a minimum viable version of the platform incorporating these findings. Implications. This innovation has the potential to scale the development of PtDAs and ultimately support evidence-based and preference-sensitive clinical decisions.

Highlights

This formative research presents an innovative infrastructure designed to scale patient decision aids through capacity-building tools and standardized templates.

Stakeholder feedback suggests that the platform could enable more timely and resource-efficient development of decision aids, although its effectiveness has yet to be evaluated.

The platform’s collaborative features could foster partnerships between developers, clinicians, and patients by promoting a shared understanding of the process and making roles and decisions about content more transparent.

To increase confidence in the quality of decision aids, future work should introduce a validation process for decision aids and integrate evidence-synthesis guidance into the platform.

Graphical abstract

Keywords

co-design decision support techniques health communication health technology implementation Normalization Process Theory (NPT)patient and public engagement scale-up infrastructure shared decision making stakeholder engagement

Patient decision aids (PtDAs) are evidence-based tools that prepare patients and their family or friend caregivers to actively participate in shared decision making with their health care provider.¹ PtDAs provide information about options and associated benefits/harms and help guide patient decisions by complementing and facilitating counseling by the health care provider.^2,3 They have been shown to improve knowledge and lead to more accurate risk perceptions.¹ With the impetus from research funding, as well as national or regional programs and policies, PtDAs are now increasingly in demand among clinicians and health care organizations worldwide in a wide array of clinical contexts.⁴ This growing demand is not limited to higher-income countries; there is also pressure to improve access in countries where person-centered care and shared decision making are emerging, such as Mexico and Malaysia.⁴ Providing clinicians and policy makers in these contexts the means to develop, adapt, and update PtDAs could significantly support the implementation of shared decision making,⁵ which is increasingly recognized as part of value-based health care.^6–8

However, the widespread adoption of PtDAs is limited by their availability. From a practical perspective, the current production—primarily led by researchers—is insufficient to meet demand. A key barrier is the specialized expertise required to develop PtDAs that meet the International Patient Decision Aid Standards (IPDAS),^2,9 ensuring their quality and effectiveness. In addition, PtDA development is resource intensive and complex, requiring evidence review¹⁰ and the involvement of multiple stakeholders such as researchers, patients, clinicians, and health care managers.^11–13 Achieving early stakeholder involvement, despite its benefits in creating ownership and buy-in,^14–20 adds significant complexity and demands to the PtDA development process, requiring multiple cycles of evaluation and feedback between users and developers in a user-centered approach,^20,21 which also requires substantial resources. Financial costs further constrain PtDA development. Users increasingly expect interactive, Web-based PtDAs,^13,22 which are more expensive to develop, especially when considering recommended user testing.²³ Moreover, ongoing resources are required to keep PtDAs up to date.²⁴

Beyond these significant practical challenges, the widespread adoption and successful integration of PtDAs into routine clinical practice also fundamentally depend on understanding the complex social and organizational processes through which new innovations become embedded within existing contexts. This often-overlooked dynamic, termed normalization, involves the work actors do in engaging with a new practice. Normalization Process Theory (NPT) provides a robust framework for understanding this dynamic process by articulating 4 interrelated constructs that represent the domains of this work: Coherence (sense-making work), Cognitive Participation (relational work to engage others), Collective Action (operational work to enact practices), and Reflective Monitoring (appraisal work to assess and understand how practices affect people).^25,26

Efforts to scale-up PtDA production are often not well documented. Some scientific articles and PtDA directories highlight active PtDA developers,^27–30 mostly academic researchers who often lack the resources to update their PtDAs postresearch. Government agencies, professional organizations, and public bodies also develop PtDAs, but in limited numbers, and they are subject to policy changes. There are also professional PtDA developers who aim to scale and sustain PtDA development through revenue generation, either nonprofit or for-profit. For example, EBSCO offers subscription-based PtDAs with DynaMed evidence summaries, and MAGICapp offers features for developing PtDAs based on clinical practice guidelines. Healthwise offers numerous free interactive PtDAs, although its business model is unclear. These developers typically operate centralized PtDA development services funded by subscription fees from health care organizations, clinicians, or patients. However, the business models are not always transparent on their Web sites.

To address these multifaceted barriers—including the need for specialized expertise, high resource intensity, the limitations of centralized and often unsustainable development models, and unclear business models—we set out to develop an innovative infrastructure: a digital platform called PADA (A Collaborative Platform for Authors of Healthcare Decision Aids; Giguere). This platform promotes the decentralization of PtDA development by building capacity and offering a validated generic template, thereby optimizing resources and overcoming key obstacles to widespread PtDA availability.

This study aimed to develop and optimize a mock-up of the platform with key stakeholders and to identify factors that could influence its adoption by knowledge users in order to ultimately support its future implementation. We drew on the NPT to describe these factors and guide the iterative optimization of this innovation in collaboration with end users and other stakeholders.

Methods

Study Design

We used a people-centered and collaborative approach to design an alpha version of the platform. We then optimized it in an improved beta version by conducting individual interviews with key stakeholders to explore their perceptions of the platform in a qualitative, descriptive study design.

This study is part of a larger project that also examined participants’ perceptions of the PtDA template generated through the platform (manuscript currently in preparation). We prepared this report in compliance with COREQ guidelines.³¹ All participants signed an information and consent form.

Innovation Design

We structured the design of the platform using the Design Council’s Framework for Innovation,³² a recent revision of the Double Diamond model from 2004, which promotes a commitment to innovation from a people-centered and collaborative perspective and comprises 4 phases: Discover and Define (in a challenge-oriented diamond) and Develop and Deliver (in an outcome-oriented diamond) (Figure 1).

Figure 1.

Adaptation of the Framework for Innovation³² to guide the iterative design of the platform by the Design and Development team through people-centered engagement of key stakeholders.

A core design and development team led the iterative design process, which was supported by input from an advisory panel. The core design and development team consisted of the project leader, who is a content expert (A.G.); a computer analyst (P.F.); a user interface/user experience designer (E.B.); and the first author, a public health student (J.B.). The advisory panel consisted of potential end users (C.B., P.B., K.S., F.L., B.D.T., D.S., K.H.), patient representatives (J.L., K.P.), clinicians (P.B., F.L., K.S., D.S., S.E.S., B.V.), a technical expert (P.D.), and implementation experts (E.D., A.G., F.L., D.S., S.E.S.). Several team members are part of the IPDAS collaboration (A.G., C.B., F.L., D.S.).

Discover and Define

In keeping with the Design Council Framework’s “Discover” phase, we began by articulating the need for a scalable PtDA development platform. The project leader’s (A.G.’s) first-hand experience (more than 30 PtDAs created) and insights from her research network highlighted a recurring demand from government agencies, practice-based research networks, and academic teams for timely, high-quality PtDA development. These requests often exceeded the scope of ad hoc academic collaboration.

We then conducted a comprehensive analysis of existing PtDA development initiatives, as described in the introduction. This analysis included academic, government, and commercial offerings (e.g., DynaMed, MAGICapp, Healthwise, The Ottawa Hospital Research Institute) and confirmed that there is a significant unmet need in this area.

Then, as per the “Define” phase of the framework—informed by the identified unmet needs, theoretical frameworks,^11,33 and the evidence-based IPDAS criteria⁹—the design and development team specified the core user needs and challenges that the platform sought to address. This stage also involved defining the platform’s core requirements, including key functionalities and users’ stories.

This preliminary description of the core requirements was subsequently reviewed by members of the advisory panel, who were invited to provide written feedback in a shared online document, enabling them to build on one another’s perspectives.

Develop and Deliver

Based on the refined description of the platform obtained through the Discover and Define phases, the design and development team (E.B.) developed a high-fidelity mock-up of the platform using Figma (version 11, Figma Inc., San Francisco). This mock-up was a detailed visual representation that provided users with a clear conceptualization of the future platform’s interface and user experience, without requiring a fully functional prototype. The mock-up was meant to serve as a critical formative assessment tool, allowing for early and cost-effective feedback on the proposed design before significant development resources were committed.

Members of the advisory panel subsequently reviewed this alpha mock-up, providing feedback either individually or in a group setting. Their collective input led to the development of an improved mock-up version.

We then used a systematic and iterative approach to improve the mock-up based on key stakeholders’ assessments of the platform, as described in the next sections.

Recruitment

Through the team’s professional networks, we recruited a convenient maximum-variation sample of key stakeholders in PtDA development, striving to diversify their continent of residence, native language, and gender. We defined a key stakeholder as an individual who had participated or planned to participate in the development of a PtDA, for example, as a project manager, scientific reviewer, patient or clinical expert, or health care manager, or in a more specialized role (e.g., biostatistician, translator, graphic designer, or health literacy expert). To participate, interested stakeholders had to be at least 18 y old; speak fluent English, French, or Spanish; be able to read English; and have access to a computer with a camera and a stable Internet connection. People who had a hierarchical relationship with any member of the research team were ineligible.

Invitations were made through French-, Spanish-, and English-speaking shared decision-making networks and the Facebook page of the Shared-Decision-Making Society. We sought to recruit a sample of 24 participants, or until saturation, which we defined as the point at which no new main theme emerges.³⁴

Data Collection

The data collection and analysis, as well as the optimization of the platform, were based on the NPT as recommended by the authors and users of the theory.^25,35,36 The application of NPT to the project can be found in Supplementary Material 1.

Upon recruitment, participants completed an online survey to describe their sociodemographic characteristics and experience in PtDA development.

Participants were asked for feedback on the mock-up in individual, think-aloud interviews³⁷ via videoconference, which lasted approximately 1 h and were video-recorded and transcribed verbatim. We showed participants the PtDA template created with the platform at the beginning of the interview so that they could understand its purpose. Participants were then asked to complete specific tasks related to capturing and revising the text of a PtDA using the mock-up while sharing their screen. The moderator encouraged participants to say aloud what they were thinking during the process, answered participants’ questions, and noted when they needed help. This strategy allowed for user feedback on usability (e.g., navigation, terminology).

After completing the different tasks, participants were asked a series of open-ended questions to assess their perception of factors that might affect the uptake of the platform. These questions followed a semi-structured interview guide based on NPT,²⁶ which was pilot tested in our research team (Supplementary Material 2). A logbook was kept throughout the study to document observations that were not recorded.

The first author (J.B.) conducted the interviews and had no relationship with the participants prior to the study. She was new to the field of shared decision making and had no assumptions about what the participants’ responses would be. She conducted this work as part of her graduate training in research and public health.

Between interviews, the issues raised were discussed among team members to find solutions to improve the mock-up. The number of interviews conducted before integrating changes into the mock-up depended on the level of importance of the issues raised, reflecting the team’s previous experiences, resources, and literature on user-centered design.^38,39 This user-centered design process continued until we reached saturation, as defined above.

Data Analysis

Three researchers conducted mixed deductive–inductive thematic qualitative analysis of the recording transcripts⁴⁰ using NVivo⁴¹: a master’s student in public health (J.B.), a bachelor’s student in psychology (L.Z.M.), and a researcher (PhD) in public health (A.G.). We used a deductive approach initially by predefining nodes for each of the 4 NPT constructs (Coherence, Cognitive Participation, Collective Action, Reflexive Monitoring).²⁵ Under each construct, we also created nodes for its subcomponents (e.g., Enrollment, Legitimation, Activation under Cognitive Participation), forming a parent–child node structure in NVivo. As we analyzed transcripts, we inductively created additional child nodes—representing emergent subthemes—nested under the relevant component node. By organizing nodes into parent (construct) and child (component or subtheme) relationships, we captured both theory-driven and emergent insights.

Usability issues surfaced through moderator-guided think-aloud tasks (e.g., navigation confusion, unclear labels, interruptions) and were inductively coded under Collective Action, namely, under the Interactional Workability component within this construct, aligning real-time user-centered feedback with the work to operationalize PtDA creation using the platform.

The 3 researchers first independently analyzed part of a first interview and established consensus on some subthemes. Then, they analyzed a second part of an interview based on this consensus, met again, and so on until they had reached an acceptable understanding of the research objectives and themes. After this initial analysis, 1 person (J.B.) analyzed each of the remaining interviews and a second person reviewed the subthemes and corresponding transcripts (L.Z.M.). Any subthemes that emerged were reviewed and agreed on by consensus between the 3 researchers.

Results

Discover and Define Findings

In the initial Discover and Define stages, we identified 3 core challenges faced by developers of PtDAs: 1) ensuring that PtDAs meet the rigorous quality standards outlined by IPDAS, in order to be both useful to patients and work as intended⁹; 2) actively engaging a diverse group of stakeholders—including patients, clinicians, and decision makers—through a structured, iterative process to incorporate feedback and enhance the relevance and adoption of the PtDA²¹; and 3) offering interactive PtDAs online, which often requires significant technical and financial resources that may not be readily available in all settings.

Our landscape analysis of existing PtDA development initiatives highlighted a lack of transparent, flexible, and broadly accessible tools that empower diverse stakeholders to develop high-quality, sustainable PtDAs. Specifically, while some platforms offered structured evidence-based content or evidence summaries, they often lacked robust features for multistakeholder collaboration, flexible content development beyond clinical guidelines, and transparent business models for sustained operations.

Supplementary Material 3 describes the detailed requirement specifications, personas, and user stories that were developed during these formative phases and subsequently used to create the mock-up.

The Platform

The platform is an interactive and user-friendly online environment designed to support the systematic development of PtDAs. It integrates previously validated printable and Web-based templates that fulfill the IPDAS criteria.^42,43 A description of the platform is available on the PADA Web site.⁴⁴

The platform is structured around 3 main modules (see Table 1 for a detailed list of all functionalities): the Edition module guides authors through the content development process for their PtDA, the Revision module facilitates collaborative work among an unlimited number of stakeholders on the same PtDA, and the Consultation module allows end users (clinicians or patients) to view the developed PtDAs. Notably, the Revision module was conceived to meet one of the IPDAS criteria of the development domain (i.e., potential users were involved in designing, developing, and/or refining a prototype).⁴⁵ In addition, one feature of the Edition module was specifically focused on empowering PtDA authors to fulfil IPDAS criteria in their development processes, namely, “Checking the PtDA content against IPDAS criteria and health literacy design principles” (Table 1).

Table 1

Description of the Different Modules, Intended Users, and Main Functionalities of the Platform^a

Module and Target User	Main Functionalities
Edition moduleInternal team (e.g., scientific reviewer, biostatistician, graphic designer, translator, health literacy expert)	• Insert content into a PtDA template and visualize its integration in a Preview Mode while writing• Work collaboratively and simultaneously with multiple team members on the same PtDA• Translate content or adapt content to a different context• Adapt content to a lower health literacy level• Select colors; insert a logo, icons, or images• Check the PtDA content against IPDAS criteria and health literacy design principles• Declare conflicts of interests• Select certain optional features (e.g., values clarification, GRADE ratings of the quality of evidence)
Revision moduleAdvisory committee (e.g., health professional experts, community worker experts, patient experts, healthcare manager)	• Preview the PtDA• Comment and suggest changes to the PtDA content
Consultation modulePatients, health professionals, public	• View and use the PtDAs produced using the platform
Administration moduleProject manager and platform administrator	• Manage a team• View team activities• View older PtDA versions• Publish PtDAs• Review analytics (anonymized patient activities on the Web site)• Share or distributing PtDAs• Evaluate PtDA users’ knowledge before and after reading a PtDA• Update PtDAs regularly
Training moduleMembers of the internal team or advisory committee	• Access training on the development of PtDA• Upload resources to share with other PtDA authors

IPDAS, International Patient Decision Aid Standards; PtDA, patient decision aid.

The minimum viable product created from the mock-up can be accessed through the PADA website upon request.

The proposed business model to sustain the platform involves authors paying for licenses to create freely accessible PtDAs.

Similar to MAGICapp, the platform will provide resources for structuring evidence-based tools but with a distinct emphasis on user-centered design by offering dedicated revision features for input from advisory committee members and end users. Unlike MAGICapp, the content of the PtDAs produced will not be tied to clinical guidelines, allowing for formats that deviate from traditional recommendation-based messaging.

Develop and Deliver Findings

During the user reviews of the alpha mock-up version, the advisory panel and subsequent interview participants provided valuable feedback.

We significantly modified the mock-up on 3 occasions: after the advisory panel review, after 8 participant interviews, and then at the end, after all 20 interviews were completed. Several minor modifications were also made to the mock-up over the course of the process. These modifications are listed in Supplementary Material 4.

Participant Characteristics

We interviewed 20 participants including researchers, clinician–researchers, patient experts, and health care managers (Table 2). Thirteen interviews were conducted in English and 7 in French. Fifteen participants lived in high-income countries and 5 in upper-middle-income countries, as defined by the World Bank.⁴⁶ While most participants had developed 2 to 5 PtDAs, their experience ranged from 0 to 80 PtDAs developed. The 2 participants who had never developed a PtDA were planning to develop one.

Table 2

Characteristics of Study Participants

Characteristic	Frequency (%), N = 20
Gender
Female	11 (55)
Male	9 (45)
Age (y)
18–34	2 (10)
35–49	6 (30)
50–64	6 (30)
65 and older	6 (30)
Country of residence
Canada	5 (25)
Malaysia	4 (20)
France	3 (15)
United States	2 (10)
Belgium	1 (5)
Brazil	1 (5)
Denmark	1 (5)
Germany	1 (5)
Norway	1 (5)
Singapore	1 (5)
Race (some participants identified with 2 races)
White	13 (65)
Chinese	3 (15)
Black	2 (10)
Latin American	1 (5)
Southeast Asian	1 (5)
Unspecified	1 (5)
Language most spoken at work
English	9 (45)
French	7 (35)
Danish	1 (5)
German	1 (5)
Norwegian	1 (5)
Portuguese	1 (5)
Education
High school	1 (5)
University	19 (95)
Experience in PtDA development (n PtDA developed)
None	2 (10)
1	2 (10)
2–5	9 (45)
6–10	5 (25)
>10	2 (10)
Main role in PtDA development
Researcher/clinician–researcher	15 (75)
Patient	4 (20)
Health care manager	1 (5)

Factors Influencing the Adoption of the Platform

We reported our findings according to each construct, dividing them among positive and negative perceptions. The most striking results are presented in the text below, and more information is available in Tables 3 to 6.

Table 3

Participants’ Positive (+) and Negative (−) Perceptions of the Platform Relative to the Coherence Construct

Construct Component (Deductive Codes) and Emergent Subthemes (Inductive Codes)
1.1 Differentiation
(+) Web-based version allows implementation of analytics about patients’ use of PtDAs (EN-01)
Differences with known PtDAs or tools to develop PtDAs
(−) Platform—some features missing as compared with current tools for PtDA development (EN-12)
(+) Platform offers a unique service (EN-01, EN-06)
(+) Platform offers an overview of all PtDA aspects (FR-13)
Sense-making and appreciation of specific features
(−) Unclear how analytics about author’s use of platform works (EN-01)
(+) Collaboration feature is unique (EN-01, EN-10, EN-21)
(+) Feature to review in context is valuable (EN-22)
Sense-making of the PtDA template (Decision box) template provided
(−) Could be limiting to have only 1 PtDA template (FR-01)
(+) Providing a template for PtDAs is the main benefit of the platform (FR-03, FR-06, FR-14)
Familiarity with known technologies or PtDAs
(+) PtDA template, the Decision Box, is like PtDAs that they developed (EN-22)
(+) Platform similar to other Web site creation software (EN-02)
(+) Review function similar to other revision tools (EN-01, EN-03)
(+) Worked in the past on a similar platform that was never completed (EN-22)
1.2 Communal Specification
Effects of collaborative work
(−) Collaborative aspect needs to strike a better balance between inclusivity and protection of ownership for hot PtDA topics (FR-13)
(+) Review function makes it easier to work with your team (EN-05, EN-06, EN-10, EN-20, FR-03)
Functions to access and adapt existing PtDAs—to allow communal work
(−) No option to gain access and visibility to other PtDAs on the same subject, to avoid duplication (FR-01)
(−) No option to replicate previously developed PtDAs or sections while keeping track of authorship (EN-12)
(+) PtDAs using the generic template could be adapted to specific contexts (FR-13)
Usefulness for patients as stakeholders
(−) Need to emphasize some of the terminology to clarify the objectives when presenting the platform (FR-06)
(+) Allows the creation of PtDAs that will increase patient participation (FR-06)
1.3 Individual Specification
(−) It would be helpful and simple to add optional emotional scales used by some authors (FR-04)
(+) Similar functioning to other tools used in their work (EN-01)
Effects on specific tasks of each author
(−) A separate document should be proposed to write the content of the PtDA before using the platform (FR-04)
(+) Meets the needs of authors for a template and a digital solution to develop PtDAs (EN-10, EN-22)
(+) Facilitates different tasks for the author (EN-05)
(+) Helpful as a writing aid to start a PtDA and organize the content (FR-05)
1.4 Internalization
(+) Possibility to add other languages for the PtDA (EN-05, EN-21, FR-03)
Anticipated barriers to making the platform part of author practices
(−) PtDAs are already integrated in some electronic medical records (FR-03)
(−) Requires some time to become familiar with the features (EN-01, EN-03)
Practicality of using the platform
(+) Allows customization (EN-02, EN-12, FR-05)
(+) IPDAS criteria are important and easier to follow with the platform (EN-12)
(+) Time-saving feature for revision (EN-22)
(+) Practical for organizing work and structuring the PtDA (FR-01)
Value of the platform for the future of PtDA development
(+) Allows authors to create quality Web-based PtDAs that are in demand, given limited resources (EN-22, FR-04)
(+) The Dbox template is useful, and is cost- and time-effective (EN-01, EN-04, FR-04, FR-06)
(+) Template allows authors to continuously develop Web-based PtDAs effectively over the long term (EN-04, EN-21)
Value of the PtDA template
(+) Critical elements are covered, and this PtDA template is useful in most situations (EN-20)
(+) Evidence-based template (EN-01)

PtDA, patient decision aid.

Table 4

Participants’ Positive (+) and Negative (−) Perceptions of the Platform Relative to the Cognitive Participation Construct

Construct Component (Deductive Codes) and Emergent Subthemes (Inductive Codes)
2.1 Initiation
(−) The implementation of any innovation is difficult (EN-04)
(+) Perceived ease of use of the platform because of the available template (EN-01, FR-03)
Anticipation of the PtDA publication process
(−) Does not fit their government requirements to publish all PtDAs on a national platform (EN-22)
(+) Posting PtDAs on Web sites of renowned institutions will help reach patients more effectively (EN-04)
First impressions on the uptake of the platform
(−) Requirement for user training could hinder use of the platform (FR-04)
(+) If multiple versions and pricing are considered, like with other software, this could open access to more users (FR-04)
(+) Using the platform for their work seems feasible (FR-03)
(+) Willingness to start using the platform (EN-11, EN-22, EN-23)
2.2 Enrollment
(+) Structure places users in an active role that allows greater participation (FR-05)
(+) Could be a useful tool for modifying and implementing previous PtDAs in different languages (EN-21)
Users’ willingness to engage with the platform
(−) Adoption of this new way of working could be difficult, and some collaborators will not do it (FR-14)
(+) Willingness to pay to develop PtDAs with the platform (EN-21)
(+) Wishes to access platform when ready (EN-02, EN-03, EN-12, EN-22, FR-01, FR-05)
Value of the platform for different users
(−) Experienced authors already have fixed structure for their PtDAs and would not change them for the platform (EN-06)
(+) First-time authors or authors of a small number of PtDAs would be interested (EN-06)
(+) Regional health directors and content experts likely to find the platform useful to adapt existing PtDAs to their context (FR-14)
(+) Useful for both first-time and experienced authors (EN-11)
2.3 Legitimation
(+) Would use the platform to ensure longevity of their PtDAs and content (EN-03, EN-12, EN-22)
Functionalities to support participation of different types of stakeholders
(+) Involves patients who can disseminate the use of the platform (FR-06)
(+) Possibility to add health managers as authors in the platform (FR-13)
(+) Regional organizations looking for tools tailored to their population might benefit especially from the platform (FR-14)
Supporting valid contribution from all authors
(+) Collaboration is easier for all stakeholders (EN-02, EN-11)
(+) Features of the platform allow the user to make a useful contribution (FR-13)
2.4 Activation
(−) No option to contact the programmer or the designer for support (EN-04)
Customizability to sustain platform use
(−) Multiple templates would be useful to accommodate the needs of different topics (EN-23, FR-14)
(+) Freedom to customize PtDAs and add logos will help promote use of the platform (FR-14)
Fostering new partnerships when using the platform
(−) No option for authors to communicate with and get reviews from other experts and users (FR-01)
(+) Interest in developing a partnership between countries (FR-05)
Promoting the platform to their teams
(+) Wishes to access the platform for their research center when ready, with funding (EN-01)
(+) Wishes to access the platform for their team, provided other languages can be made available (EN-22)
(+) Would recommend the platform to collaborators (EN-22)

PtDA, patient decision aid.

Table 5

Participants’ Positive (+) and Negative (−) Perceptions of the Platform Relative to the Collective Action Construct

Construct Component (deductive codes) and Emergent Subthemes (inductive codes)
3.1 Interactional Workability
**For usability, see Additional Files 2
(−) Greater flexibility to change titles, and the flow of the PtDA would encourage its use (EN-10)
(+) Analytics about author use of platform is a valued feature (EN-01)
Operationalization of revision and collaboration tasks
(+) Feature to visualize content facilitates revision of PtDAs and collaboration (EN-01, EN-05, EN-06)
(+) Friendly enough to include all types of stakeholders (FR-13)
(+) Network and potential collaboration emerging from use of the same platform (FR-01, FR-14)
(+) Platform is key to facilitating collaboration (EN-23, FR-04)
(+) Revision feature helps collect genuine feedback from nonexperts (EN-20)
Operationalizing work relating to languages
(−) Having an option for automatic translation could facilitate the work (EN-11)
(−) Comments written in the language of each member complexifies use of the platform (FR-03)
3.2 Relational Integration
(−) Unclear to patients that PtDAs listed on the dashboard are there for them to edit, not to use (FR-13)
Author training to ensure quality of PtDAs
(−) No guidelines on presenting evidence-based health information (EN-22)
(−) No guidelines on how to respect IPDAS criteria (EN-22)
(−) Without proper training, users will not be able to synthesize evidence to create quality content for the PtDA (EN-05, EN-06, EN-22)
Confidence when working with multiple collaborators
(−) Assigning multiple collaborators to writing content may result in different writing styles (EN-12)
(−) Lack of version-tracking option limits possibility of editing with collaborators (EN-20)
(−) No option to upload and share reference materials or existing content with collaborators (FR-13)
(+) Allows sharing of team members’ practical expertise in clinical communication (EN-01)
(+) Review function is valuable for collaboration among team members (EN-11, FR-03, FR-05)
3.3 Skillset Workability
(−) Recommendations in PtDAs should still include referrals to professional coaching or counseling (FR-04)
(+) Participant expressed interest in developing a training structure for the platform (FR-05)
Features for each type of stakeholder
(+) Allows team members to be autonomous and efficient (EN-01, FR-06)
(+) Different features allow access to complementary expertise from patients and clinicians (EN-01, EN-04)
3.4 Contextual Integration
(−) Concerns about copyright and regulations for scientific publications required of researchers (FR-01)
(+) Feasibility of Web-based training for the platform (FR-05)
Authors’ internal resources
(−) PtDAs created by authors who lack skills and resources for systematic reviews could be less thorough (FR-04)
(+) Useful for new authors without resources to create a whole Web site (EN-06)
Costs
(−) Cost could be a barrier to using the platform (EN-04, EN-05, EN-11, FR-04)
(+) Cost would likely match the budget for a small research start-up fund (FR-04)
(+) Free for patients to consult the resulting PtDA (EN-21)
Access to PtDAs by patients in different contexts
(−) Access to PtDAs on electronic tablets or touch screens needed for older populations and those with limitations (FR-04)
(+) Multiple language options (EN-04, EN-11)
Flexibility of the template for different contexts
(−) Implementation would be facilitated with flexible branding and hosting options for different institutions (EN-04, EN-10)
(−) Implementation would be facilitated with greater template flexibility for different populations and problems (EN-22)
(+) Customizable for any topic and context (EN-05, EN-10, EN-11, EN-23)
Implementation of the platform in institutions
(−) Not suitable to incorporate PtDAs into electronic medical records (EN-21)
(+) Platform could be helpful for centers that create decision aids (EN-01)

PtDA, patient decision aid.

Table 6

Participants’ Positive (+) and Negative (−) perceptions of the Platform Relative to the Reflexive Monitoring Construct

Construct Component (Deductive Codes) and Emergent Subthemes (Inductive Codes)
4.1 Systematization
(+) Consistency among PtDAs developed using the platform (FR-01)
(+) Potential of the platform to have a positive impact on PtDA development (FR-14)
Analytics and data
(−) No analytics to study PtDA use by patients (EN-01)
(−) Unclear how PtDAs and data on platform users will be managed (EN-12)
Information required to ensure PtDA quality
(−) There should be qualified reviewers to check PtDAs before they are published (EN-22)
(+) Every PtDA that clinicians see must be trustworthy and evidence based to implement SDM, which will be possible with the training linked to the platform (EN-22)
Perceptions of the platform’s workflow
(−) Does not replace the PtDA development steps required prior to using the platform (EN-21)
(+) Option to resume work at one’s own pace (FR-05)
4.2 Communal Appraisal
(+) Nonspecific positive comment (EN-05, EN-12)
Effects on teamwork
(+) Allows teams without Web designers to create Web-based PtDAs (EN-06, FR-03)
(+) Platform facilitates team’s process of creating PtDAs (EN-05)
(+) Template will allow cheaper and simpler development of Web-based PtDAs (FR-04)
Perception of platform value for other users
(−) Trust in the platform would be higher if certification was required for users (FR-04)
(+) Helps transform patient–clinician relationship (FR-05)
4.3 Individual Appraisal
(−) Dashboard has too much information (EN-01)
(−) Having an example of both a simple and complex PtDA would enhance the creative process for all types of authors (EN-23)
Individual perception of the PtDAs created
Individual perception of the platform
(+) Can imagine themselves using the platform because it would be helpful (EN-01, FR-06)
(+) Structure encourages ease of use (EN-05, FR-06)
(+) User-friendly language and setup (EN-02, EN-22)
4.4 Reconfiguration
(−) No option for positive feedback and rewards for authors (EN-02)
Adaptations to allow collaboration with patients as authors
(−) Should consider adding a place to share positive insights from patients (EN-02)
(+) Guidance helps to gather patient input and avoid negative outcomes (EN-02)
Additional revision features to consider for future versions
(−) Should consider allowing collaborators to rewrite text and track revisions (EN-06)
(+) Revision feature is already comprehensive, although further details could be added later as needed (EN-20)

PtDA, decision aid; SDM, shared decision making.

Coherence

Under the Coherence theme, we have included participants’ comments on how they understand the platform and what it would mean for them to use it to develop PtDAs (Table 3).

Participants clearly understood the unique features of the platform, for example, for collaboration between authors and for revising the PtDA in a “preview” mode at any point during its development.

They found the PtDA templates useful, and some even considered them to be the biggest advantage of the platform, as they are evidence based and save time. One of the patient participants thought that it could be limiting to offer only a few PtDA templates and suggested that several should be offered to better meet needs, for example, by organizing the information differently.

Participants also appreciated the fact that the platform worked similarly to other text-editing applications they were already using, such as Google Docs™ or Microsoft Word™, creating a sense of familiarity.

One participant mentioned that he felt the platform offered something different from the way he currently worked:

What we did with our decision aids is we developed a content management system, as you did. But our content management is only developed to show the content as it is [without formatting], but it’s not to create certain sections or certain tools [complete PtDAs]. So, I think, this one is much more interactive and much more . . . flexible than ours is. (EN-06, researcher with >10 PtDAs)

Participants felt that the review features of the platform would promote a shared understanding of the aims and expected benefits of the platform, particularly for patient experts.

Participants also considered the significance of the platform for their individual work as authors. Many found the platform helpful, such as this participant:

I think that it will make our work much easier, especially if you had features to present icon arrays; it will make my life easier because it is really difficult sometimes to talk to the designer, what to do, what you want, what do you need. So, I think if you can do it by yourself, it will be really nice. (EN-05, researcher with 2–5 PtDAs)

Participants appreciated the practicality of the platform and felt that it could be integrated into their routine practice. However, some mentioned that some of the features require familiarization.

They also felt that the platform would help in the long run to create high-quality Web-based PtDAs, even with limited resources:

So, compared to those I have developed, I started from scratch, I designed it, they look very nice, but at the end of developing, I’m so tired because it took so much time. It looks good, but it is not sustainable. . . . So, this kind of multiple templates, though it might not look so . . . as fancy or as tailored, it achieves its purpose of developing a PDA very quickly and effectively. (EN-04, clinician with 5 PtDAs)

One participant suggested adding a step in which the content of the PtDA is written in a separate document before being transferred to the platform.

Cognitive Participation

The Cognitive Participation theme reflects participants’ views on how the platform supports PtDA developers in building and maintaining a community of practice around its use.

The initial reaction of many participants to the platform was that they would be willing to push for its use. Several of them expressed interest in using the platform as soon as it is available.

It would be nice if, once you have completed this project, we could use the platform. (EN-03, clinician with 2 PtDAs)

Participants felt that they could rely on the available Web-based and printable PtDA templates (Table 4).

While participants expected that offering PtDAs on the Web sites of renowned institutions would help to better reach patients, they were also concerned that the PtDAs would not meet their government’s requirements to be published on a national platform. Participants also mentioned that the platform should enable the promotion of their PtDAs through reputable institutions, suggesting that the publication and distribution processes should consider the needs of individual institutions (e.g., governments, universities, and hospitals).

One participant was concerned that requiring mandatory training for authors might hinder the platform’s adoption. Referring to an existing online training program for PtDA developers,⁴⁷ they questioned whether such an approach would be appropriate:

In Ottawa, there is a kind of credit course, a tutorial. At the end you’re asked a lot of questions, and you get a certificate, a kind of diploma. Should we do the same? But would that slow down the use [of the platform]? I don’t know, but maybe it’s a recommendation. I don’t know. (FR-14, health care manager with 1 PtDA)

Participants also felt that the structure offered by the platform would support collective work and user participation:

So, I click on “Aspirin for cardiovascular disease,” and there’s a paragraph that tells me what stage the project is at. If I have a concern, I can ask, “Please add the finance director from such-and-such Integrated Care and Social Services Center as a collaborator, because he had to make decisions and present this to the board of directors, which wasn’t easy.” Then, I have space to write all the points that concern me to move the project forward. The platform allows for all these dimensions. (FR-13, patient without PtDA)

Some participants provided insights into the value of the platform for all types of users:

I think it will be useful for different types of authors, for the first-time author or even the experienced author who has developed many decision aids. . . For a first-time author, it is more to guide the author to follow important elements in decision aids and to follow the steps. (EN-11, clinician–researcher with 4 PtDAs)

Some participants also noted that less experienced authors and health managers would benefit most from it:

For example, if I were a doctor, a pediatrician, and I would really like to do a decision aid for my patients, but I don’t have the resources, I don’t have time to create a whole Web site, I would be very happy to use it. (EN-06, researcher with >10 PtDAs)

In contrast, some participants felt that authors with more experience in developing PtDAs might be reluctant to adopt the platform because they are already using another PtDA template:

All of our decisions aids are in the same font and in the same colors and the pictures are similar and so on and so on. Of course, if you asked me: Would you like to change all your decision aids to our template? I’m afraid I wouldn’t. (EN-06, researcher with >10 PtDAs)

In general, participants appreciated the fact that the platform would support input from all types of stakeholders. They felt that the platform would facilitate collaboration with patient experts, organizations, and health managers:

I’m happy to see that this [the platform’s way of working on PtDA content] allows for more details, it is more customizable for both [collaborators], or all three, or however many partners there are. A caregiver partner can then add the things that are important for them. (EN-02, patient with 3 PtDAs)

Participants also saw the platform as a way to facilitate PtDA updates and keep them relevant, which they described as an ongoing concern:

Moderator: “What is different in this platform from conventional methods to develop decision aids?”

Participant: “I think there’s a certain plasticity, so it’s very plastic. It feels like you can play around with different things before it gets launched. It also means that the . . . it kind of removes the fear of . . . in the past, when we apply for funding for decision aid, there’s always that: “who’s going to do the updating? We’re going to print these booklets, how long are these booklets going to be useful for?” This one, it seems that there’s more longevity for the decision aid, bringing the promise that the decision aid could go on for a much longer time than just showing it once. That’s my feeling. I think it was quite positive, actually. (EN-12, researcher with 6 PtDAs)

Some participants were ready to promote the platform to their collaborators, teams, or research centers. In contrast, others mentioned specific features to be added beforehand, such as the possibility of adding logos to PtDAs or having access to several PtDA templates.

Collective Action and Usability

The Collective Action theme summarizes participant views on operationalizing the processes to create PtDAs using the platform, such as tasks, resources, and interactions between the authors. We have integrated all comments on the usability of the platform here.

Overall, participants appreciated the fact that the platform’s revision features allow them to work with an advisory committee, which was highlighted by this participant:

Because it really enables, especially nonexperts, to say: “Okay, I’m reading this and I have this reaction,” and so it is real world, representing what a user would feel about it. (EN-20, researcher with > 10 PtDAs)

In addition, some participants felt that the platform’s features could support all types of stakeholders by enabling them to work autonomously and efficiently and to share their complementary expertise (Table 5).

Several participants mentioned that it would be valuable if the platform offered the possibility to develop PtDAs in several languages, and these comments touched on the NPT themes (Tables 3 –5). Under the Collective Action theme, some explained that having multiple language options would improve access to PtDA by patients in different contexts. Some participants also mentioned the importance of being able to work in several languages, and one of them felt that there should be an automatic translation option.

Several participants saw it as a strength that the platform could support the training of authors and ensure the quality of PtDAs. For instance, one individual pointed out that some authors may not be comfortable with synthesizing and presenting evidence:

Do you have anything, like some guidelines, about how to get the evidence or results from studies into the decision aid? Because that’s the most important, and also the most difficult thing, with all decision aids. (EN-22, clinician–researcher with 4 PtDAs)

While most participants felt that the platform’s revision features would enhance collaboration, additional features such as version tracking and sharing of reference materials were also suggested to enhance collaboration. Some also suggested that adding functionality to replicate or adapt existing PtDAs while tracking authorship would benefit collaborative work, and some recommended that the platform provide professional coaching and counseling.

Participants mentioned that the lack of resources (e.g., skills, funds, and time) would be an incentive to use the platform, but it could also limit the quality of the PtDAs produced.

Several participants felt that the costs to access the platform and create the PtDA might pose a barrier:

With a template like this, we can just put in our content. I think that will be very good. I’m just wondering whether you would allow a user to use it for free. (EN-11, clinician–researcher with 4 PtDAs)

Lastly, several participants appreciated the flexibility of the platform—in terms of languages, institutions, formats, and populations—to adapt the PtDAs to their different contexts; however, some pointed out certain challenges in implementing PtDAs in electronic medical records.

Usability

Several minor usability issues were identified, such as unclear navigation, low visibility of key features (e.g., Infotips, preview), and misunderstandings regarding the required content. These issues were relatively easy to resolve. A detailed summary of the factors influencing the usability of the platform can be found in Supplementary Material 5.

Overall, the platform was perceived as user friendly. By the last round of interviews, adjustments had been made based on participant feedback, and the features and navigation were considered intuitive. For example, participants appreciated the built-in “Infotips” that provided clear instructions for completing each section. They also unanimously praised the planned feature displaying PtDA’s readability level.

In previous rounds, some participants expressed a desire for the platform to support inexperienced authors in complying with IPDAS standards when creating content. In response, we added a checklist that allows authors to self-assess their PtDA against the IPDAS standards, similar to the approach used in the Ottawa Decision Aid Library Inventory.⁴⁸ Participants responded favorably to this feature in subsequent rounds.

Most of the negative feedback related to missing elements. In particular, participants wanted greater flexibility in the inclusion of images, videos, graphics, testimonials, and icon arrays throughout all sections of the PtDA.

Reflexive Monitoring

The fourth construct, Reflexive Monitoring, summarizes participants’ insights into monitoring and evaluating the effects of the platform on PtDA development processes and patient outcomes (Table 6).

One participant felt that the platform could improve PtDA development and help disseminate trustworthy and evidence-based PtDAs:

I think it has . . . the potential to have a significant impact on the creation of decision aids. (FR-14, health care manager with 1 PtDA)

Some participants mentioned that offering certification of the PtDA could help build trust in the platform and the resulting decision aids. Some also felt that trust in the platform could be improved if the PtDAs were reviewed by qualified reviewers before publication.

The ability of the platform to provide detailed login/access information (e.g., patient usage of PtDAs) was considered valuable, as long as user data management remains transparent.

Participants also saw the platform as beneficial for teams lacking full access to the necessary expertise:

It saves time; it saves resources. For example, we didn’t have a graphic designer, so we had to hire someone from outside the institution, and that took a lot of time. (FR-03, clinician with 3 PtDAs)

Lastly, the participants said they could imagine adopting the platform in the long term. One patient expert felt that the platform could support successful collaboration between researchers and patients by guiding the patients on the types of input researchers want:

So, sometimes questions with the best of intentions to determine values and beliefs resonate differently with us [patients]. So, these are the things that I look for: the way you’re putting things forward, how are we going to hear it? How are we going to interpret them? So, this gives me great confidence. (EN-02, patient with 3 PtDAs)

Saturation

We estimated that we reached data saturation as there were no new themes created in the last 4 interviews.³⁴

Discussion

In seeking to understand the factors that influence the uptake of a collaborative platform for the development of PtDAs, we have identified 5 key determinants of success: that scaling PtDA development requires adaptive platforms that offer a range of flexible templates, that meaningful co-design depends on interactive feedback modalities, that global implementation requires a focus on guided cultural adaptation to ensure equity, that a platform must function as a sociotechnical ecosystem that integrates training and quality assurance, and that such platforms can serve to democratize PtDA development by bridging resource gaps. Each of these determinants is discussed below.

Participants appreciated the platform’s evidence-based PtDA templates because they ensure adherence to IPDAS and improve development efficiency. Converging with this finding, a recent systematic review suggested that the use of templates for PtDA creation could reduce the need for iterations and extensive revisions, thus facilitating PtDA scaling.²¹ In addition, PtDA templates have been successfully used in several large-scale implementation studies.^17,49,50 However, our study reveals a critical insight for scalability in practice. We found that a “one-size-fits-all” approach is insufficient; participants emphasized that, to be useful, the platform must function as an adaptive system by offering a range of flexible and diverse PtDA templates suited for different clinical contexts. This adaptability is essential to allow the customization needed to support successful scaling of shared decision making across varied settings.

Our research highlights a significant flaw in the traditional PtDA co-design process, which often relies on stakeholders commenting on text-heavy Word documents. Participants believed the platform’s features to preview and comment on a fully designed PtDA would foster a shared understanding of the PtDA development process among users and allow for more valuable feedback, especially from inexperienced authors. People understand information better when it incorporates colors,^51,52 a clear layout,^51–54 images or graphics,^51,55 and paragraphs with white space.^52,53 Moreover, a previous large-scale PtDA implementation study found that key stakeholders’ understanding of their respective roles is crucial for participatory design.⁵⁶ Participants also valued the fact that the platform enabled iterative and simultaneous revisions by multiple stakeholders, including patients, clinicians, health managers, and designers, as this enhanced collaboration would support more meaningful interactions and result in PtDAs that are better aligned with user needs. A previous study on user-centered design for the development of mobile health services has shown that collaboration between designers and stakeholders indeed improves product usability.²³

Participants identified several factors influencing the platform’s successful implementation, emphasizing the need for flexibility in branding, hosting, and PtDA costs. They also discussed the need for embedding PtDAs in electronic medical records or integrating them into government programs, which have been identified as key to PtDA implementation in previous studies.^57–59 Several participants also appreciated the platform’s translation potential to meet the needs of patients in different contexts. Although translation could enable a wider range of PtDAs at a lower cost,²⁷ it must take into account not only language differences but also cultural norms and health-literacy variations. A recent report from Malaysia, for example, highlighted the challenges of developing and implementing PtDAs due to the country’s multiethnic population (Malay, Chinese, and Indian communities), different religious beliefs about health, and the influential role of spouses and family members in medical decision making.⁶⁰ Relying solely on machine translation and automated literacy assessments could therefore overlook these nuances and even exacerbate social inequalities.⁶¹ To mitigate these risks, future platform development must include not only translation capabilities but also educational support and guidance to promote evidence-based cultural adaptation processes as described in the PACE framework.⁶² Automated literacy assessment also does not ensure true accessibility, even if more comprehensive automated tools are developed.⁶³

Our study shows that a development tool alone is insufficient to ensure user confidence and adoption; instead, the platform must function as a sociotechnical ecosystem that integrates training, coaching, and quality assurance pathways. Participants expressed the need for training on evidence synthesis and risk communication, echoing a systematic review that concluded that scaling strategies are successful when supported by both infrastructure and human resources.⁶⁴ They emphasized that PtDAs must reflect the best available research⁶⁵ and be communicated clearly¹⁰—expectations that training modules or coaching could help meet by guiding the evidence selection, synthesis, and presentation, following best-practice guidelines.⁶⁶ Training could include links to existing programs focused on PtDA development.^48,67 From an NPT perspective, such training or coaching could strengthen user confidence in the quality of PtDAs and their impact on patient outcomes. The platform could also support evidence transparency, by requiring developers to include a literature synthesis report with each PtDA, which can be downloadable as a PDF so that users can easily access the supporting evidence. Participants also mentioned that confidence would increase if qualified reviewers assessed PtDAs prior to publication, which is consistent with concerns that accelerating PtDA development could reduce formal academic assessment.⁶⁸ Current PtDA certification initiatives in the United States could serve as inspiration.^69,70 As the platform is aimed at researchers, among others, it could also facilitate compliance with the SUNDAE reporting guidelines, which aim to improve the quality of publications evaluating PtDAs.⁷¹ To facilitate compliance, the platform could offer a “SUNDAE Wizard” that prompts developers to complete each item on the checklist. Overall, these features position the platform not only as a production tool but also as a structured system that fosters capacity building and the development of trustworthy, high-quality PtDAs.

Finally, our work identifies the platform’s potential to democratize PtDA development and promote global health equity. Participants felt that while all PtDA authors could benefit from the platform’s community of practice, it was most critical for those with less experience or fewer resources. Lack of experience may limit an author’s ability to meet quality criteria,² theoretically assess user needs,³³ and take a systematic, iterative approach to soliciting user feedback.^13,21 The financial and human resources required^13,39 may also burden the occasional or inexperienced author. The platform could efficiently guide these authors while reducing development costs. In so doing, the collaborative digital platform could strategically address the global imbalance in shared decision-making implementation,⁴ thereby positioning itself as a key policy tool for building capacity and increasing the availability of relevant PtDAs in settings where they are needed most.

Limitations

We assembled a relatively diverse sample in terms of gender and stakeholder type, but with limited diversity in language and country types, which limits the transferability of our findings. Our difficulties in recruiting authors from middle- and low-income countries reflect current challenges in implementing shared decision making globally.⁴ For example, shared decision making in Latin American countries often does not include PtDAs,^4,72 and this impeded our recruitment efforts there. We did not recruit participants who were unaware of shared decision making; however, some of the participants had not yet developed PtDAs. Therefore, our results may not apply to people who are not aware of shared decision making at all.

Another limitation is that we did not formally evaluate each user suggestion against the IPDAS criteria. Instead, we used the IPDAS standards as a nonnegotiable filter throughout the development of the platform and included only usability or engagement improvements that maintained the core, evidence-based principles.

Conclusions

In this formative study, we identified user requirements and initial perceptions of a PtDA development platform designed to streamline capacity building and collaboration. Stakeholders indicated that translation support, template libraries, and embedded guidance could address common resource and coordination challenges. Next steps include creating a beta version of the platform, potentially as a minimum viable product; usability testing with early adopters in their own environments, to identify any remaining issues in practice; then evaluating the effect on development efficiency and—ultimately—patient engagement and outcomes. By grounding future work in rigorous evaluation, we hope to determine whether this platform can meaningfully advance the scalability and implementation of high-quality PtDAs in routine care.

Supplemental Material

sj-docx-1-mpp-10.1177_23814683251409185 – Supplemental material for Factors Influencing the Adoption of a Patient Decision Aid Development Platform: A Qualitative Study

Supplemental material, sj-docx-1-mpp-10.1177_23814683251409185 for Factors Influencing the Adoption of a Patient Decision Aid Development Platform: A Qualitative Study by Julie Bélanger, Carissa Bonner, Paulina Bravo, émilie Dionne, Katherine Hastings, France Légaré, Karina Prévost, Kevin Selby, Dawn Stacey, Sharon E. Straus, Brett D. Thombs and Anik Giguere in MDM Policy & Practice

Supplemental Material

sj-pdf-2-mpp-10.1177_23814683251409185 – Supplemental material for Factors Influencing the Adoption of a Patient Decision Aid Development Platform: A Qualitative Study

Supplemental material, sj-pdf-2-mpp-10.1177_23814683251409185 for Factors Influencing the Adoption of a Patient Decision Aid Development Platform: A Qualitative Study by Julie Bélanger, Carissa Bonner, Paulina Bravo, émilie Dionne, Katherine Hastings, France Légaré, Karina Prévost, Kevin Selby, Dawn Stacey, Sharon E. Straus, Brett D. Thombs and Anik Giguere in MDM Policy & Practice

Supplemental Material

sj-docx-3-mpp-10.1177_23814683251409185 – Supplemental material for Factors Influencing the Adoption of a Patient Decision Aid Development Platform: A Qualitative Study

Supplemental material, sj-docx-3-mpp-10.1177_23814683251409185 for Factors Influencing the Adoption of a Patient Decision Aid Development Platform: A Qualitative Study by Julie Bélanger, Carissa Bonner, Paulina Bravo, émilie Dionne, Katherine Hastings, France Légaré, Karina Prévost, Kevin Selby, Dawn Stacey, Sharon E. Straus, Brett D. Thombs and Anik Giguere in MDM Policy & Practice

Supplemental Material

sj-docx-4-mpp-10.1177_23814683251409185 – Supplemental material for Factors Influencing the Adoption of a Patient Decision Aid Development Platform: A Qualitative Study

Supplemental material, sj-docx-4-mpp-10.1177_23814683251409185 for Factors Influencing the Adoption of a Patient Decision Aid Development Platform: A Qualitative Study by Julie Bélanger, Carissa Bonner, Paulina Bravo, émilie Dionne, Katherine Hastings, France Légaré, Karina Prévost, Kevin Selby, Dawn Stacey, Sharon E. Straus, Brett D. Thombs and Anik Giguere in MDM Policy & Practice

Supplemental Material

sj-docx-5-mpp-10.1177_23814683251409185 – Supplemental material for Factors Influencing the Adoption of a Patient Decision Aid Development Platform: A Qualitative Study

Supplemental material, sj-docx-5-mpp-10.1177_23814683251409185 for Factors Influencing the Adoption of a Patient Decision Aid Development Platform: A Qualitative Study by Julie Bélanger, Carissa Bonner, Paulina Bravo, émilie Dionne, Katherine Hastings, France Légaré, Karina Prévost, Kevin Selby, Dawn Stacey, Sharon E. Straus, Brett D. Thombs and Anik Giguere in MDM Policy & Practice

Footnotes

Acknowledgements

We would like to thank Philipe Fekete (P.F.) and Émilie Beaulieu (E.B.) from the Web agency Toumoro for their collaboration in the development of the PADA mock-up and Philippe Després (P.D.) and Jean Légaré (J.L.) for their support in planning this study. We also thank Anne-Gabrielle Ouellet for transcribing the interviews, Lizette Zamora Martinez (L.Z.M.) for transcriptions and qualitative analysis and Beatriz Valera (B.V.) for translating the research documents into Spanish and assisting with data collection.

This work was presented at the International Shared Decision Making Conference in Kolding, Denmark, in June 2022 and at the meeting of the Association Canadienne Française pour l’avancement des Savoirs (ACFAS) in Québec City, Canada, in May 2022.

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The development of PADA was funded by the Unité de Soutien SSA Québec. JB also received scholarships from the Québec Excellence Centre on Aging and the VITAM Research Center on Sustainable Health.

Ethical Considerations

The study protocol was approved by the sectoral ethics committee for research in health sciences at Université Laval (approval No. 2021-161/06-07-2021).

Consent to Participate

All participants signed an information and consent form. Consent to participate was written.

Consent for Publication

Not applicable.

ORCID iDs

Carissa Bonner

Paulina Bravo

France Légaré

Dawn Stacey

Brett D. Thombs

Anik Giguere

Data Availability

The research data will be made available upon request to the corresponding author, Anik Giguere.

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