%0 Journal Article
%T Reducing complexity of patient decision aids for community-based older adults with dementia and their caregivers: multiple case study of Decision Boxes
%A Anik M C Giguere
%A Edeltraut Kr£¿ger
%A France L¨¦gar¨¦
%A Gabriel Bilodeau
%A Holly Witteman
%A Juliette Lafontaine-Bruneau
%A Marie-Claude Tremblay
%A Philippe Voyer
%J -
%D 2019
%R 10.1136/bmjopen-2018-027727
%X Objectives To identify patient decision aids¡¯ features to limit their complexity for older adults with dementia and their family caregivers.

Design Mixed method, multiple case study within a user-centred design (UCD) approach.

Setting Community-based healthcare in the province of Quebec in Canada.

Participants 23 older persons (aged 65+ years) with dementia and their 27 family caregivers.

Results During three UCD evaluation-modification rounds, participants identified strengths and weaknesses of the patient decision aids¡¯ content and visual design that influenced their complexity. Weaknesses of content included a lack of understanding of the decision aids¡¯ purpose and target audience, missing information, irrelevant content and issues with terminology and sentence structure. Weaknesses of visual design included critics about the decision aids¡¯ general layout (density, length, navigation) and their lack of pictures. In response, the design team implemented a series of practical features and design strategies, comprising: a clear expression of the patient decision aids' purpose through simple text, picture and personal stories; systematic and frequent use of pictograms illustrating key points and helping structure patient decision aids' general layout; a glossary; removal of scientific references from the main document; personal stories to clarify more difficult concepts; a contact section to facilitate implementation of the selected option; GRADE ratings to convey the quality of the evidence; a values clarification exercise formatted as a checklist and presented at the beginning of the document to streamline navigation; involvement of a panel of patient/caregiver partners to guide expression of patient priorities; editing of the text to a sixth grade reading level; UCD process to optimise comprehensiveness and relevance of content and training of patients/caregivers in shared decision-making.

Conclusions The revised template for patient decision aids is designed to meet the needs of adults living with dementia and their caregivers better, which may translate into fewer evaluation-modification rounds
%U https://bmjopen.bmj.com/content/9/5/e027727