title: How to develop web-based decision support interventions for patients: a process map.
abstract: OBJECTIVE
  Significant advances have been made in the development of decision support interventions, also called decision aids, for patients facing difficult or uncertain decisions. However, challenges related to the definition, the theoretical underpinnings, the relative contribution of different components and how to migrate these tools to the Internet, remain unresolved. We propose a systematic process map for others to consider as they develop web-based, perhaps multimedia, decision support interventions and to examine the future challenges faced by developers.
  
  
  METHODS
  Based on our experiences of developing and evaluating web-based decision support interventions, we outline a process map to illustrate the general principles of content specification followed by creative design and tailoring to the target audience.
  
  
  RESULTS
  Content specification is fundamental and it should go beyond the traditional emphasis on scientific evidence in order to ensure patients' perspectives on the proposed options. The creative design phase aims to develop a medium to achieve three fundamental tasks: present information; achieve accurate affective forecasting; provide a basis for preference construction. This phase should be an open to experimentation and, where empirical work may be difficult or not yet available, guided by consultation with users, using an iterative method of trial and adaptation.
  
  
  CONCLUSIONS
  There is little empirical research on how best to achieve these tasks. The guiding principle needs to be one of customising the delivery, based on close consultation with the target users and an iterative development process until the intervention is deemed accessible and useful.
  
  
  CONCLUSIONS
  The process map provides a basis for further developments and outlines areas where remaining challenges need further investigation.
authors.affiliation: Decision Laboratory, Clinical Epidemiology Interdisciplinary Research Group, Department of Primary Care and Public Health, Cardiff University, Heath Park, Cardiff CF14 4YS, UK. elwyng@cardiff.ac.uk
authors.forename: Glyn
authors.initials: G
authors.lastname: Elwyn
authors.forename: Ilse
authors.initials: I
authors.lastname: Kreuwel
authors.forename: Marie Anne
authors.initials: MA
authors.lastname: Durand
authors.forename: Stephanie
authors.initials: S
authors.lastname: Sivell
authors.forename: Natalie
authors.initials: N
authors.lastname: Joseph-Williams
authors.forename: Rhodri
authors.initials: R
authors.lastname: Evans
authors.forename: Adrian
authors.initials: A
authors.lastname: Edwards
mesh_terms: D003142:Communication; D003657:Decision Making; D003661:Decision Support Techniques; D004645:Empathy; D006801:Humans; D020407:Internet; D017060:Patient Satisfaction; D018802:Patient-Centered Care / Q000379:methods*; D010817:Physician-Patient Relations; D012017:Referral and Consultation