Effective decision subscale
This subscale reflects the final decision and whether choices were well-informed, which points to the level of satisfaction with the process. The mean score for this subscale showed no conflict (mean = 22.73; SD = 15.61), and there were no significant differences between groups (Group 1 reported conflict on how effective the decision-process was mainly because the data was not adequately informed. For example, one participant explained that the low efficacy of the drug and low quality of the evidence hinder the process of decision-making and deciding what is most important. Group 2 showed a slightly higher level of conflict compared to Group 1 because some participants (29%) felt that the value elicitation exercises did not include aspects that were important in their decision-making (such as long-term effects). In Group 3, we found there was better satisfaction (no conflict < 25) with the process compared to the other two groups (> 25). Some participants (50%) highlighted the role of the value elicitation exercises to feel more involved in the decision-making process; however, other participants (25%) thought the exercises could be confusing (low conflict > 25-<37.5)), especially the VAS (for them, it is always important to be in ‘good health’). Although all participants from Group 3 responded that the decision analysis was useful to confirm their decision, half of the participants (50%) would not trust the decision analysis model alone to make the final decision; they would prioritize their own desires and would appreciate the support of their health professional.In Table Summary of findingsINFORMED(knowledge of the decision)♣ Knowledge on the condition♣ Previous experience with the treatment♣ Graphical representation to deliver information on risk reductionVALUE CLARITY(how clear preferences are in the decision)♣ Value elicitation exercises♣ Decision analysisSUPPORT IN THE DECISION-MAKING(if the amount of information provided is enough to support their decision-making process)♣ Evidence-based information♣ Decision analysis♣ Low efficacy of the treatment for risk reduction♣ Need of health professional to support the decision-making processUNCERTAINTY(how sure participants are with the decision and how easy it was to make the decision)♣ Low certainty of the evidence♣ Decision analysis recommendation not on favor or against the treatmentEFFECTIVE DECISION(adequately and appropriately informed decision-making, and satisfaction with the decision-making process)♣ Value elicitation exercises♣ Decision analysisIn Table Strengths and challenges of each SDM intervention component





-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.- 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.

- Need to provide information in a timely manner.