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Table 2 Strengths of e-learning component of the program

From: User-centered and theory-based design of a professional training program on shared decision-making with older adults living with neurocognitive disorders: a mixed-methods study

Themes and subthemes Illustrative citation
Valued content
Introduction module (overview of the activity): clear, relevant, comprehensive, and trusted “It was really comprehensive, and the video was very helpful.” (Nurse #16, Round #3)
Shared Decision-making module: interesting, relevant, novel, important, clear, uses useful examples, and use of an appropriate terminology for the “Watchful Waiting” option “What’s interesting is the fact that it doesn’t necessarily apply to every decision. You know, I would have thought they would say: ‘Shared decision-making must be the focus of every decision made with your patients.’ […]. I think it’s good it’s not being presented as a dogma where you don’t have the right to make a decision.” (Physician #7, Round #2)
Risk Communication module: relevant, appropriate, allows understanding patient perceptions of numbers, and interesting information on the level of evidence “You have to realize that people don’t all have the same level of education, and the way I understand something may not be the same way my patient sees it. It makes you realize things; it makes you question yourself and your competencies.” (Physician #3, Round #1)
Patient Preferences module: foundational to shared decision-making, interesting, useful prompt of the five key behaviours in the SDM process, and valued content on the climate conducive to dialogue “I found this part really important because, in my opinion, it’s the crux of the approach. What I mean is that if we don’t approach the matter properly with the patient, then we’re not respecting their values and preferences, and we’re missing something. So this is something that’s really meaningful to me.” (Social worker #9, Round 2)
Implementation module: interesting, valued exercise on the barriers/myths in implementing SDM, and overall supportive of implementation of shared decision-making “I like it because it brings us back a bit to the pre-test with any preconceived notions we may have had, and it debunks them. It provides solutions. Honestly, I think it’s a really good section.” (Physician #13, Round #3)
Instructional design supportive of learning
Narrated slides: appropriate learning modality, changes of narrators between modules are appreciated, images and visual design appreciated “I think it’s good because it’s interactive, there’s someone talking to you, explaining it to you, with slides. It’s easy to understand. They don’t go into long-winded explanations.” (Nurse #1, Round #1)
Film displaying implementation of shared decision-making: good synthesis, hands-on, a realistic example of SDM application and of decision box use, the demonstration of best practices is valued (as opposed to the demonstration of bad practices), the interactive exercise after viewing of the film is appreciated to allow critical appraisal of the behaviour displayed “As a matter of fact, it’s probably the most interesting part because in the beginning it’s all theory, and then, it’s more about practice, so in my view, it’s extremely relevant.” (Physician #5, Round #1)
Quiz on numeracy: allows becoming aware of the challenges of risk communication, requires reflection, fun, and appropriate learning modality with questions-answers “Sure, it puts us to the test! [laughs]. But it makes you realize that we all have different skillsets, including comprehension… “ (Physician #3, Round #1)
Exercise on the barriers/myths related to shared decision-making: appropriate learning modality as it is interactive, realistic in that it describes typical myths propagated by HCPs “It’s really interactive. I like that. Not too much reading. Point form. I just retain information better that way.” (Physician #13, Round #3)
Introduction video: clear, brief, and visual “It puts things into context nicely. I really like the part where she shows what the website looks like and the different features of it.” (Physician #13, Round #3)
Personal stories using videos with avatars: integrate much information, and nice format “I’ll remember the little avatar guy. It’s a good memory aid. Like pop-up reminders: ‘Oh yeah, I need to take out such and such a thing’ or ‘That reminds me of my patient’… because we have no shortage of documents, about antibiotics, about this or that… I found it interesting, the use of a visual aspect like that… it’s a bit ‘lighter’” (Physician #5, Round #1)
Overall program: allows bringing everyone to the same level, appreciated integration with the directory of decision boxes, valued the diversity of learning modalities, topics well-illustrated, appropriate length, clear navigation throughout program “The interactive features you put in were not too long. They were at just the right time, and it mixed up the rhythm a bit. I thought it was really good.” (Physician #13, Round #3)
Critical appraisal exercise: appreciated that some part of the text is highlighted, well-synthesized, clear, novel information, appreciated interactivity, challenging “Of course, I’m really on the ground and very hands-on. So, when I have to deal with research findings and scientific language, you lose me a bit. But what I found good was that you put the main message in bold. You don’t have to read the whole statement. I just read the part in bold and I got the gist of it.” (Social worker #15, Round #3)
To Learn More section: appreciated “It’s really good because there are always people who want to learn more or investigate further. If there’s something they didn’t understand, they can go directly to the sources, which I thought was good.” (Social worker #15, Round #3)