Table 3 Alpha testing illustrative participant quotes

1. Acceptability

1.a. Facilitating shared decision-making

Nurse 12: “It’s just empowering them isn’t it and it’s giving them, well it’s giving them a voice, it’s allowing them to actually make a choice without just hearing one side of it from a doctor. It’s actually allowing them to think about, well first of all its actually letting them know that they have a choice, it isn’t just you need a stent and then it’s letting them be able to have the knowledge about both options and maybe with the help of doctors and nurses, come to a decision”

1.b. Improving care processes

Nurse 10: “If they’ve got these things to discuss, it would make the pre-assessment a bit more like personal to each patient, if you had this before pre-assessment, you’d be like right I’m going to talk to them about this, this and this. Whereas at the moment you kind of have a bit of a spiel and then you go off what the person kind of says back to you and if they’ve been able to do this at the, in their home, rather than doing a questionnaire or anything when you’re there with them, they’re being a bit more honest maybe and I like the score”

1.c. Quality and safety in practice

Cardiologist 1: “I think the benefit of this, if you get the patient to fill it in, it might actually start to make some doctors think are we actually doing the right thing for this patient? So, I think for the wrong reasons it might have the right effect”

2. Usability

2.a. Accessibility

Patient 5: “The only slight downside and I’m thinking of my mum here, she can be very IT averse and can feel threatened by it. But to me it’s, its straightforward and easy enough. Whereas someone a bit older might, well not older, but IT averse”

2.b. Navigation

Patient 6: “Maybe some, yeah, quick navigation buttons to get you back to the home page menu, main menu, something like that”

2.c. Functionality

Cardiologist 4: “It would be helpful, yeah, that would be helpful. Yeah, so I think what you’re saying is that yeah, exporting this output is really helpful. Whether email is like an option is open to debate. So, I know, you know, if there’s an option to export to pdf and then I don’t know, somehow send it in such a way that it’s just attached to the electronic patient record or something, then that’s really useful”

3. Comprehensibility

3.a. Language

Patient 6: “Again it’s explaining all in nice straightforward non-technical terms, but then starts then giving me some names that I can’t say, atherosclerosis”

3.b. Interpretation of information

Researcher: “What do you think of having the picture there with the people?”

Patient 7: “Oh it’s easier than saying one in three thousand or something like that, you might as well just look at it and say I might be him”

Patient’s partner 7: “If you’re not mathematically inclined that’s quite a good way of doing it, you know, you think what’s one in one hundred, no that’s rather good that”

4. Content

4.a. Accuracy of content

Cardiologist 1: “That’s just wrong. One in a thousand. The BCIS wouldn’t quote that. It’s about one in a hundred. So that’s, that to me looks as if there’s no risk, doesn’t it?”

4.b. Balanced view of treatment options

Nurse 3: “I like that side by side, I thought that was quite good how you could do the little snapshot. I know it wasn’t in as much detail as the bigger options, but you could see side by side as like a, you’re doing it to make a choice aren’t you, so it’s showing you the pros and cons of each one and how they might fit for you”

4.c. Personalisation of decision aid

Patient 14: “Well it’s good to have it all as a summary, having been through the bits and perhaps forgotten about some of them and having the list of questions written down”

4.d. Value elicitation method

Patient 9: “I think that might be quite good, that use this space to write down any concerns or questions that you want to discuss with your doctor. That might be, that might focus your mind to actually prepare yourself for a visit to the doctor so that you actually have your questions. I mean sometimes it’s a good idea just to write them out yourself”

5. Desirability

5.a. Presentation

Cardiologist 15: “Maybe the text should be bigger because its, I don’t know, for elderly patients, they might struggle to read some of the smaller, I guess it depends how big the screen is doesn’t it? Maybe it’s a bit small, the text, for older patients to read. But nice setup”

5.b. Use of multimedia

Patient 2: “The visual aspect there just leaps out straight away and says right that’s the problem you’ve got, there it is, that’s what we do and that’s, once the balloon is taken out, it's left in as that”