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Table 2 Stakeholder engagement meeting final recommendations for the BEFORE (Begin Exploring Fertility Options, Risks, and Expectations) decision aid

From: The "Begin Exploring Fertility Options, Risks and Expectations" (BEFORE) decision aid: development and alpha testing of a fertility tool for premenopausal breast cancer patients

Break-out Group Session Final Recommendations
 1. Presentation of statistics − Use pictographs for the visual presentation of statistics on the pregnancy success rates for each fertility option
− Reduce the denominator from 100 to 10
− Use a gender-neutral image for the pictograph images to ensure inclusivity
 2. Inclusion and formatting of an explicit values clarification method − All participants felt that an explicit values clarification method should be included as an optional tool for those patients who want to use it
− Most participants preferred the Likert-scale format with pre-listed values and blank spaces for patients to add in their own values
− Suggested modifying the scale headings to ‘important to me’ and ‘not as important to me’ for the values
 3a. Inclusion and formatting of personal stories − Personal stories through videos, quotes, and forums were viewed as beneficial for inclusion
− Caution was expressed on ‘recreating the wheel’ as many stories exist online currently
− Diverse patients and modern stories were requested to ensure representation and a sense of personalization for the patient viewing the story
− Recommendations to include ‘quotes of wisdom’ from breast cancer survivors throughout the decision aid
 3b. Dissemination strategies National/Broad Strategies
− Determining a host location to reach as many young breast cancer patients as possible (e.g., national cancer organizations or advocacy groups)
− National dissemination (e.g., providing links to the decision aid through national cancer organizations or advocacy groups)
− Add to the curriculum for medical students as well as continuing medical education for health care providers already in practice
− Advertise the decision aid in medical journals
− Search engine optimization for the online decision aid
Local Strategies
− Flag use of the decision aid in electronic medical records
− Include use of decision aid in physician checklists
− Provide information and dissemination in general surgery updates, tumour boards, or multidisciplinary cancer conferences
− Directed patient advertising (e.g., have posters on the walls of physician office)
− Survivor and health care provider champions