Table 4 Factors related to users’ experience of the Decision Box and frequency of interviews where they were mentioned (Men = participant from the men’s group; Wo = participant from the women’s group, MD = participant from the physicians’ group; FR = French-speaking group; En = English-speaking group)

a) Accessing the Decision Box *

- As printed document/not as printed document

It has some important information that I could just have handy instead of looking on the Internet at that moment. (MD-En)

2

2

- In an electronic format

You can use something electronic if you’re sitting in front of a computer and you show your patient the screen. (MD-En)

2

- As mobile version

Now that it exists as application for our pocket computers, we do not carry this with us all around. (MD-Fr)

2

- Multi-channel distribution

I actually like having something physical, especially if it’s going to be used to counsel patients. I like an Internet link to educate myself. (MD-En)

1

b) Having a positive first impression

Appropriate/inappropriate titles

I was expecting pros, cons. This is kind of what I went through with the pregnancy with Cedric. I had to go through understanding the pros and the cons and debating whether I wanted to do it or not. (Wo-En)

3

3

Credibility/lack of credibility

it’s going to have more credibility when they know that there is no drug company. (MD-En)

3

1

Too much text or too many numbers, too dense

Too busy, too busy. (MD-En)

3

Sound, explicit methodology

It needs to come from an organization that can say, “Look, we did the research, and this is what we know in 2011. We will update the box in 2013 at the latest.” (MD-Fr)

3

Simplicity - length

It’s like a cheat sheet. On a cheat sheet, you would squeeze everything, every tiny little drop that you could. This is a cheat sheet and it’s all in one page. I’m happy. (MD-En)

3

Good color choice

I think, color wise, it works fine because there is nothing that is offensive here. You don’t have a lot of red which may be more scary than other colors so, color wise I think it works well. (Men-En)

3

Including/not including an introduction

It has a good presentation section that says [to the physician], this document is about this and that, and after it’s described to you, then you will “get it” (…) It is not like having it on my desk without preparation. (MD-Fr)

2

2

Information differs from participants’ prior knowledge

At present, so many patients are screened. Why…what’s the story, why are specialists proposing such things, you know. How did we get to this point? (MD-En)

2

Time contraints

I thought it was going to be, like, an algorithm, that I can follow. And this is not. I would not have time to read it for sure.(MD-En)

1

c) Finding and understanding the information in the Decision Box

Information understandable/not understandable

I think it’s clear. I mean, it gives you… it makes a statement. And then, it shows… it gives you the explanation of that statement. And if you read both of them, you realize that first statement is just being explained on this right hand side. I think it’s pretty clear. (Men-En)

5

6

Appropriate/inappropriate format of graphics

When I first looked at it, I said: “Oh, the graphics are quite… not complicated but there’s lots of stuff on it”. (MD-En)

3

6

Missing information

We are often doing the rectal touch together with PSA testing…They only describe the PSA here…I would have preferred that they discuss rectal touch too. (MD-Fr)

6

Appropriate/inappropriate format of numbers

If you say your chance is .5%, well that sounds a lot better than saying, you know, 5 out of a thousand. (MD-En)

3

5

Good source of information

Could it be a good sheet for physicians that do not see pregnancies often, for residents? I think that yes. In these cases, there is interesting information, really substantiated.

5

Develops critical thinking

Patients, too, learn that medicine is not perfect. We are in a high-technology era; everybody thinks that we can do anything, that we can know everything. It’s a widespread idea. This makes it possible to set the record straight for us and for patients. (MD-Fr)

4

Allows conceptualization

It helps us conceptualize. (MD-Fr)

4

Inappropriate language or style

The second sentence, what is the test for, it allows the patient to decide to end the pregnancy. It’s written negatively. It should be either to continue or to end the pregnancy. (Wo-En)

4

Data presented but not found

Talking about age, it says here that the risk of trisomy increases with age of the pregnant woman. It would be good to know by how much. (Wo-En)

4

Information too basic

When I first saw this, it seemed to me that every doctor should know this already. By heart, without even consulting it. In all honesty, it seems to me the information here is pretty basic. (Wo-En)

3

Bold important words and use more bullets

The other thing I would say is that, again, for the bottom part, the benefits of screening and the harms of screening, as for the previous, I think it would be more useful to have it a little bit more [text] bulleted and bold. (MD-En)

2

Appropriate to have both words and graphics

It’s good that there is a graphic side and a text side, even if in one way, the same information is found in both places. There is information for people who learn best when they see something and information for those who like to read. (Wo-Fr)

1

Objectivity/subjectivity

Somebody has a preconceived notion, who wrote this, that you should not, that it’s not a good idea to go through the screening. And they framed it in that way. (Men-En)

4

3

Confidence in results section improves credibility/undermines credibility

It says it’s a moderate, single study of moderate quality. So, you know, it’s not the best. (Men-En)

1

4

References not detailed enough

Is this study a knowledge synthesis, meaning that they took information from everywhere and synthesized it? Or is it a single study? (…) If they verified in 3-4 types of study sites, for me that counts more than a study that was performed in a single location. (Wo-Fr)

4

Information differs from what participant already knows

I am glad to know this side of the story, but I’d like to see the other side. Cancer prevention associations state that screening saves lives, but I don’t remember seeing any numbers. (MD-Fr)

4

Typos or mistakes

Optimistic results, I’ve never heard that expression. So, I was sort of already thrown off. I didn’t even get to “I like this part.” (MD-En)

3

Scientific quality of the tool

It is really important to have up-to-date results. (Wo-Fr)

3

e) Communicating the information to the patient

Synthesized and simplified information

It’s obvious that it can give doctors the words they need to explain things more simply to their patients. (Men-Fr)

6

Easy/difficult to apply to individual patients

I’m 38 now. Can my doctor sit me down in 5 years and use these results to tell me, no, you don’t need to do a test, or yes, you need to do a test? I mean, it doesn’t apply. (Wo-En)

2

5

Information well-organized/Information does not flow

It’s nice how they’ve divided it. The top kind of allows them to position where their individual patient is in terms of where they are at, where their symptoms are and then the bottom section gives the broader scope of the research. (Wo-En)

4

4

Time required to use Decision Boxes would decrease with familiarity/time constraints

When the physician’s in his office, at the speed he sees me, I am not sure he’d start explaining this. (Men-Fr)

2

2

f) Seeking the patient’s values

Lack of non-scientific information

On one hand, I like that it is neutral and factual, but at the same time, I wish there were a way to make it more human, to suggest reflection. (Wo-Fr)

5

Would be good to generate discussion

If I think it can help me discuss things with a patient. You know, if it can help having more arguments or easier language or other, new knowledge, I would keep it. (MD-En)

2

Only scientific information is needed

I don’t think your doctor should question your values or your moral beliefs or your religion. It should be scientifically based. It shouldn’t open up that door. It’s personal. (Wo-En)

2

Doctor’s lack of communication skills

Even if everything is written as completely as it is here, [even if] the doctor has all the data, he can still come along and bang! be a real drip and say, “Here we go, here we go, now just go on home and think about it. Come back when you’re ready to tell me what you’ve decided.” (Wo-Fr)

2

Too complicated to be discussed with the patient

For me, in the harms [section], it makes a little more sense to have of the 1000 men screened pros and cons but not necessarily the other number. To have the “not screened” [number] makes the discussion much more complex. (MD-En)

2

g) Finding and understanding the information in the Decision Box

Lack of non-scientific information

On one hand, I like that it is neutral and factual, but at the same time, I wish there were a way to make it more human, to suggest reflection. (Wo-Fr)

5

Would be good to generate discussion

If I think it can help me discuss things with a patient. You know, if it can help having more arguments or easier language or other, new knowledge, I would keep it. (MD-En)

2

Only scientific information is needed

I don’t think your doctor should question your values or your moral beliefs or your religion. It should be scientifically based. It shouldn’t open up that door. It’s personal. (Wo-En)

2

Doctor’s lack of communication skills

Even if everything is written as completely as it is here, [even if] the doctor has all the data, he can still come along and bang! be a real drip and say, “Here we go, here we go, now just go on home and think about it. Come back when you’re ready to tell me what you’ve decided.” (Wo-Fr)

2

Too complicated to be discussed with the patient

For me, in the harms [section], it makes a little more sense to have of the 1000 men screened pros and cons but not necessarily the other number. To have the “not screened” [number] makes the discussion much more complex. (MD-En)

2

h) Trusting the information

Having appreciated using it

When we discuss something among colleagues and I say: “Look, I used this in this way and it really helped me”. If I don’t use it, there’s not much chance that I will share it with my colleagues. (MD-Fr)

4

Simplicity of the tool – length/Inappropriate size – too large

It’s simple. Like, I’m not going to hand them 15 pages. (MD-En)

1

1

Good source of new information

The fact that you said that it’s the best evidence we have, I find that interesting. (MD-En)

1

Credibility of the source

Because if you guys were sending me this, a box of these, then I would say: “Oh look the College is endorsing me to use these Decision Boxes.” Well, o.k. I’m more likely to give them to a colleague. (MD-En)

1

Clinically-based information

… But the idea that it’s clinically based…You give more credit to something like that. And you get more people to read it. (MD-En)

1

Clear concept –easy to understand

If the concept is clear enough. If it is easy to understand. (MD-Fr)

1

Difficult to apply to individual patients

I am used to talking about the triple-test. The only value added of a sheet is to cite numbers that I don’t keep in the top of my mind. People want to know their risk at 35 years old, their risk of this and that. I can’t apply this as it is. (MD-Fr)

1