Email updates

Keep up to date with the latest news and content from BMC Medical Informatics and Decision Making and BioMed Central.

Open Access Highly Accessed Open Badges Research article

Development and preliminary user testing of the DCIDA (Dynamic computer interactive decision application) for ‘nudging’ patients towards high quality decisions

Nick Bansback1234*, Linda C Li45, Larry Lynd36 and Stirling Bryan12

Author Affiliations

1 School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada

2 Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Research Institute, 7th Floor, 828 West 10th Avenue, Research Pavilion, Vancouver, BC V5Z 1M9, Canada

3 Centre for Health Evaluation and Outcome Sciences, St Paul’s Hospital, 588-1081 Burrard St, Vancouver, BC V6Z 1Y6, Canada

4 Arthritis Research Centre of Canada, 5591 No. 3 Road, Richmond, BC V6X 2C7, Canada

5 Department of Physiotherapy, University of British Columbia, 212 – 2177 Wesbrook Mall, Vancouver, BC V6T 1Z3, Canada

6 Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC V6T 1Z3, Canada

For all author emails, please log on.

BMC Medical Informatics and Decision Making 2014, 14:62  doi:10.1186/1472-6947-14-62

Published: 1 August 2014



Patient decision aids (PtDA) are developed to facilitate informed, value-based decisions about health. Research suggests that even when informed with necessary evidence and information, cognitive errors can prevent patients from choosing the option that is most congruent with their own values. We sought to utilize principles of behavioural economics to develop a computer application that presents information from conventional decision aids in a way that reduces these errors, subsequently promoting higher quality decisions.


The Dynamic Computer Interactive Decision Application (DCIDA) was developed to target four common errors that can impede quality decision making with PtDAs: unstable values, order effects, overweighting of rare events, and information overload. Healthy volunteers were recruited to an interview to use three PtDAs converted to the DCIDA on a computer equipped with an eye tracker. Participants were first used a conventional PtDA, and then subsequently used the DCIDA version. User testing was assessed based on whether respondents found the software both usable: evaluated using a) eye-tracking, b) the system usability scale, and c) user verbal responses from a ‘think aloud’ protocol; and useful: evaluated using a) eye-tracking, b) whether preferences for options were changed, and c) and the decisional conflict scale.


Of the 20 participants recruited to the study, 11 were male (55%), the mean age was 35, 18 had at least a high school education (90%), and 8 (40%) had a college or university degree. Eye-tracking results, alongside a mean system usability scale score of 73 (range 68–85), indicated a reasonable degree of usability for the DCIDA. The think aloud study suggested areas for further improvement. The DCIDA also appeared to be useful to participants wherein subjects focused more on the features of the decision that were most important to them (21% increase in time spent focusing on the most important feature). Seven subjects (25%) changed their preferred option when using DCIDA.


Preliminary results suggest that DCIDA has potential to improve the quality of patient decision-making. Next steps include larger studies to test individual components of DCIDA and feasibility testing with patients making real decisions.

Patient decision aids; Medical decision-making