title: A 'combined framework' approach to developing a patient decision aid: the PANDAs model.
abstract: BACKGROUND
  There is a lack of practical research frameworks to guide the development of patient decision aids [PtDAs]. This paper described how a PtDA was developed using the International Patient Decision Aids (IPDAS) guideline and UK Medical Research Council (UKMRC) frameworks to support patients when making treatment decisions in type 2 diabetes mellitus.
  
  
  METHODS
  This study used mixed methods to develop a PtDA for use in a UK general practice setting. A 10-member expert panel was convened to guide development and patients and clinicians were also interviewed individually using semi-structured interview guides to identify their decisional needs. Current literature was reviewed systematically to determine the best available evidence. The Ottawa Decision Support Framework was used to guide the presentation of the information and value clarification exercise. An iterative draft-review-revise process by the research team and review panel was conducted until the PtDA reached content and format 'saturation'. The PtDA was then pilot-tested by users in actual consultations to assess its acceptability and feasibility. The IPDAS and UKMRC frameworks were used throughout to inform the development process.
  
  
  RESULTS
  The PANDAs PtDA was developed systematically and iteratively. Patients and clinicians highlighted the needs for information, decisional, emotional and social support, which were incorporated into the PtDA. The literature review identified gaps in high quality evidence and variations in patient outcome reporting. The PtDA comprised five components: background of the treatment options; pros and cons of each treatment option; value clarification exercise; support needs; and readiness to decide.
  
  
  CONCLUSIONS
  This study has demonstrated the feasibility of combining the IPDAS and the UKMRC frameworks for the development and evaluation of a PtDA. Future studies should test this model for developing PtDAs across different decisions and healthcare contexts.
authors.affiliation: Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia. ngcj@um.edu.my.
authors.forename: Chirk Jenn
authors.initials: CJ
authors.lastname: Ng
authors.forename: Nigel
authors.initials: N
authors.lastname: Mathers
authors.forename: Alastair
authors.initials: A
authors.lastname: Bradley
authors.forename: Brigitte
authors.initials: B
authors.lastname: Colwell
mesh_terms: D003661:Decision Support Techniques; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D005240:Feasibility Studies; D006301:Health Services Needs and Demand; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D007407:Interviews as Topic; D008962:Models, Theoretical; D010358:Patient Participation; D011795:Surveys and Questionnaires; D006113:United Kingdom
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin