Open Access Research article

Refining a brief decision aid in stable CAD: cognitive interviews

Karen Kelly-Blake1*, Stacie Clark1, Katherine Dontje2, Adesuwa Olomu1, Rebecca C Henry1, David R Rovner1, Marilyn L Rothert2 and Margaret Holmes-Rovner1

  • * Corresponding author: Karen Kelly-Blake

  • † Equal contributors

Author Affiliations

1 College of Human Medicine, Michigan State University, East Lansing, USA

2 College of Nursing, Michigan State University, East Lansing, USA

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BMC Medical Informatics and Decision Making 2014, 14:10  doi:10.1186/1472-6947-14-10

Published: 13 February 2014



We describe the results of cognitive interviews to refine the “Making Choices©” Decision Aid (DA) for shared decision-making (SDM) about stress testing in patients with stable coronary artery disease (CAD).


We conducted a systematic development process to design a DA consistent with International Patient Decision Aid Standards (IPDAS) focused on Alpha testing criteria. Cognitive interviews were conducted with ten stable CAD patients using the “think aloud” interview technique to assess the clarity, usefulness, and design of each page of the DA.


Participants identified three main messages: 1) patients have multiple options based on stress tests and they should be discussed with a physician, 2) take care of yourself, 3) the stress test is the gold standard for determining the severity of your heart disease. Revisions corrected the inaccurate assumption of item number three.


Cognitive interviews proved critical for engaging patients in the development process and highlighted the necessity of clear message development and use of design principles that make decision materials easy to read and easy to use. Cognitive interviews appear to contribute critical information from the patient perspective to the overall systematic development process for designing decision aids.

Decision aids; Cognitive interviews; Shared decision-making; Stable CAD; Stress testing