Table 5 HCPs’ perceptions of the weaknesses of the Decision Boxes by theoretical domain.

Intention

I have no intention of changing my day-to-day approach.

“The information in the decision box will be useful to me to refresh my memory on the different protection regimes but I do not believe that I will change my way of doing things from day to day.” (Physician #31, Round #1, DB #5)

Belief about consequences of using the DB; Usefulness of the DB

The DB is not well adapted to every patient, nor is it adapted to every situation

“The facts were generally known to me, even though I did not have precise statistics. In addition, each case is different, and I do not believe that applying this box will allow me to better target the necessary interventions.” (Physician #19, Round #2, DB #3)

DBs do not add any value to clinical practice

“We understand that quality of life is the main objective, but the toolbox, although interesting, is heavy and brings nothing more to the clinical level.” (Physician #31, V3, DB #5)

DBs are not helpful to announce my own opinion/recommendation

"What is most difficult is to announce our opinions when they are very divergent from those of the patient or the family, and I do not believe that the decision box helps us." (Physician #19, Round #2, DB #3)

Statistics are useless

"The DB, while interesting, is cumbersome and brings nothing more to clinical practice."(Doctor #31, Round #3, DB #4)

The same information can be offered informally without presenting the DB

“There are many tools for different aspects of medicine, and the use of concrete tools is difficult, but the idea conveyed by these tools can be transmitted verbally to patients informally through other information.” (Physician #9, Round #1, DB #5)

Information is harmful to interprofessional collaboration

"I was surprised by the statistics that 1% to 3% of therapists commit sexual acts that could hinder the process of care. Considering the low proportion of men, the percentage of therapists with deviant behaviours seems to me to be high. I very much doubt this statistic. As I am a man, I find that this statistic might affect referral and the confidence of the doctor towards the therapists." (Social worker #69, Round #4, DB #1)

Already aware of this information

“I was aware of the facts, but not of the exact statistics.“ (Physician #19, Round #2, DB #3)

Belief about capabilities: I might not be able to use the DB to present the pros and cons of health options to patients because…

… it is challenging to access the services offering the health options described in the DB

“Accessibility remains a problem in many regions of Quebec. These data have been collected to facilitate discussion, but the bulk of the work that will ultimately increase the patient's quality of life is not the DB, but the long-term accessibility to this type of service.” (Physician #32, Round #2, DB #4).

…it is challenging to present statistics

"When patients and their family caregivers are in our office, talking about statistics is unthinkable. It is already very difficult to only talk about the reality of everyday life." (Nurse #14, Round # 2, DB #1)

…I don’t have time

‘’Office days are becoming heavier and heavier and it is now possible to use the services of our paramedical staff to convey more complete information so we can focus more on clinical tasks.” (Physician #31, Round #1, DB #5).

...I don’t know how to access the DBs.

“Access to the DB should be facilitated.” (Nurse #15, Round #2, DB #4)

Ease of Use

The DB uses unfamiliar jargon or terminology

"The terms used are legal terms and it's a tough jargon for me." (Physician #20, Round #2, DB #5)

The information is too dense and should be synthesized

"The presentation is too dense and too complex." (Physician #2, Round #1, DB #1)

The information is difficult to understand

“I found the latest data on using vs stopping medication confusing. In the Harms section, it is hard to interpret what you’re trying to show.” (Physician #32, Round #1, DB #2)

Usability of the DBs could be improved

"The Pictograms for the Confidence in the results section could be a little more visible. Could black dots be used rather than crosses? Could the circles be enlarged?" (Physician #12, Round #1, DB #1)

Social influence: My colleagues might not use the DB to present the pros and cons of health options to patients because…

…experience is more valuable than the information in the DB

"I believe that professional experience allows us to properly target the discussions to be had with patients and their families." (Physician #19, Round #2, DB #3).

...the DB is long and complex

"Too complicated, too long, and does not match the reality of work." (Nurse #14, Round #2, DB #1)

...some information is irrelevant

"There is too much irrelevant information in the tables." (Physician #30, Round #3, DB #1)

Role/identity

This topic is irrelevant to my professional role

"I think my colleagues at the clinic usually have the same habits as me and refer to our social worker for this part of the job." (Physician #31, Round #1, DB #5)