Table 3 Strengths and challenges of each SDM intervention component
Intervention component | Strengths | Challenges |
|---|---|---|
Evidence-based information | - The description of health states is very relevant to identify what factors inform the decision-making process. - Graphical representations and figures of risks and benefits are important to make them aware about the choices, and clarify what the options are. | - The factors that were contributing to the decision were arbitrary, dependent of participants preference (e.g. some people were more concerned about the use of epidural at birth, and others about the need to do something to avoid a VTE event), and influenced by their previous experiences with the condition or drug. - The low certainty of the evidence hinders the process of decision-making. - The low efficacy of a drug (small risk reductions) makes it difficult to decide what is most important. - The level of health literacy of participants influences the understanding and usefulness of the decision analysis recommendation. |
Value elicitation | -Exercises are useful to assess whether risks are more important than benefits, through a weighing process. - Exercises foster participation of participants in the decision-making process. | - Having specific health states to rate what is more important might restrict the decision-making process or aren’t comprehensive enough, and leave aside other factors that may contribute to the decision (e.g. long-term consequences). |
Decision analysis | - Reduces overall decisional conflict - It is useful to reinforce and/or confirm their decision making the process of decision-making more precise. - It improves satisfaction as their individual preferences are considered and linked to a recommendation on what is the best option. | - Having a section where the options neither favor nor are against the intervention can be confusing (they fall in the yellow area). - Would not rely on the decision analysis recommendation uniquely, and need the support of the health professional in the decision-making process - Need to provide information in a timely manner. |