Decision Aids (DAs) are intended to help individuals participate in or make health care choices in situations where outcomes may be indeterminate or dependent on values and beliefs [1, 2]. Effective DAs have been shown to improve knowledge, reduce indecision, increase decision making involvement and lower decisional conflict . Over 500 aids have been developed globally , but these have largely focused on 'rational' screening or treatment choices for conditions such as cancer and heart disease. DAs are rarely used to help those with chronic or age related conditions to make decisions about care services, and yet they represent a potentially useful resource for care-related choices in complex chronic disease situations.
Dementia is a progressive illness, resulting among other outcomes in decreasing decisional capacity. As many as 26% of people with dementia (PWD) remain living in the community, the vast majority cared for by one or more family members  who increasingly take responsibility for care decisions. The experience of caregiving, which is likely to include assistance with communication, cognition and emotion, as well as with mobility, self-care and other activities of daily living , has been described as an "unremitting burden" . This burden is correlated with poor health outcomes, such as depression and anxiety and an overall increased risk of morbidity and mortality for carers, and earlier institutionalisation for care-recipients [5–8].
Services such as respite, either in the PWD's home, in a day care centre or in a residential facility, can reduce this burden, easing-albeit temporarily-carers' physical and emotional workload [9–16]. However, respite services are under used, with only 30% of carers of PWD reporting having used a respite service even where referral has been made and services are readily accessible [3, 17–19]. Carer service choices are affected by a complex array of other factors. These include individual personality traits - carers, for example, have varying levels of tolerance for their situations  and the emotional, physical and financial costs of caring [20, 21].
A number of authors argue that carers need to give themselves 'permission' to use respite, trusting that the person they look after is being provided with quality care [19, 22–26] and that their own burden is real and in need of alleviation. In addition, Toseland et al.  suggest that health care workers can help reduce some of the barriers to accepting assistance by developing trust, adequate collaborative planning, providing information and advice, listening, clarifying for caregivers the nature of respite, and providing emotional support. At the same time, carers may gain a greater sense of control  if they are given the opportunity to "determine what respite means for them, and which services can best meet their needs" , p. 303.
Carers need access to realistic, contextually relevant information in order to make service-related decisions, and may need support to weigh up available options. Carers of PWD are therefore a suitable group for targeted DAs, given that they experience many conditions that are known to cause emotional turmoil and consequent delayed decision making [30, 31]. DAs typically contain pertinent information about the condition or disease, both the advantages and disadvantages of treatment options, activities such as weigh scales that help individuals to clarify their values by asking them to rate their perceptions of the benefits and disadvantages of different treatment or service options, and advice about the decision-making process . DAs constitute appropriate resources in the dementia carer's situation and could play a central role in helping carers to make decisions about respite services.
This two stage study developed and trialled a respite service decision aid to assist carers of PWD when making judgements about community services. The decision aid, called the GOLD Book (Guiding Options for Living with Dementia), targets primary carers of community dwelling PWD.
The two stage research was approved by the Tasmanian Human Research Ethics Committee. All study participants received an information sheet explaining the nature of the project, as well as benefits and risks of participation, and completed a consent form prior to the first round of data gathering.