Effect of the SDM intervention components on DCS
Evidence-based information reduced conflict in the decision-making process. However, when the information is based on low quality evidence, uncertainty increases. A similar study conducted in Spain [Value elicitation exercises were useful to understand what is most important (risks or benefits) in a decision, thus supporting and facilitating the weighing activity (pros and cons) in the decision-making process. These exercises also reduced uncertainty in the decision-making process by helping participants better clarify (‘what choice is best for me’) their decision. This finding is consistent with IPDAS recommendations [The provision of a decision analysis recommendation decreased uncertainty (lowest level of decisional conflict for the uncertainty subscale) and improved self-efficacy with the decision process. It helped tip the balance of pros and cons, helping participants to be more confident with their decision. In addition, participants noted the need for health professionals when implementing the decision analysis technique in the clinical encounter, to support the cognitively-demanding activity of integrating the evidence with their preferences [