Table 3 Qualitative feedback from handbook development Stage 2 (Phases 1 and 2)

Patients did not know their treatment options

“First, can you explain the two treatments? What is the difference between those two treatments?”

· Defining patients’ various treatment options

· Added a treatment definition page (“What are the Treatments?”)

· Replaced all abbreviations with actual treatment names

· Making complex medical terminology memorable

· Color-coded each treatment option

· Associated each treatment with its own icon

Intimidating amount of complex information

“And I just feel like this is so much information that's written that is not going to be taken in.”

· Translating research evidence into plain language

· Developed a question and answer format in plain language

· Revised the language in the to achieve a fourth grade reading level

· Created a new section (“What is on Each Page?”) to introduce and define research quality

· Communicating research quality

· Used pictures of “real” doctors and patients diverse in age, sex, and gender

· Placed tabs throughout the handbook to divide it into smaller sections

· Making the handbook user-friendly

· Added an interactive value clarification exercise (“How Do I Choose a Treatment?”)

Understanding numerical information or statistical concepts

“I don’t want these chances or things…it’s real confusing. I want to know the facts.”

· Presenting graphical illustrations of data

· Used graphical presentations patients responded to most positively

· Supplemented graphical presentations with text to reiterate the intended message

· Adopted a double page spread format to appeal to a diverse group of readers

· Using both positive and negative framing of statistical information

· Used an example study to anchor each head-to-head treatment comparison

· Explaining effect size

· Modified effect size terminology from a “small/medium/large amount” to “a little/somewhat/ a lot better”