Table 4.

Whether or not the ‘Kidney Failure Decision aid’ meets the needs and preferences identified in the focus group data

Topic	Needs and preferences identified in focus groups	Incorporated in the PtDA?
Education and decision-making	Don’t forget the person behind the patient*	Paper hand-out sheet, interactive website and summary sheet contain components that facilitate conversation on the personal situation, wishes, and preferences of patients
	Clearly define the patient journey and take the lead as primary practitioner*	Paper hand-out sheet contains a flowchart of the advanced CKD care pathway Interactive website contains a chapter with information on all involved clinicians, and when the decision has to be made
	Provide mentorship and guidance throughout the educational and decision-making process*	Paper hand-out sheet, interactive website, and summary sheet contain components that guide patients and clinicians in making values and preference-based decisions
	Coordinate with colleagues and adjust the education based on patients’ educational needs*	No
	Evaluate how well patients understand the provided information*	No
	Explore how patients make their choices, and who was involved in the decision-making process*	Interactive website and summary sheet contain components that facilitate conversations on who plays an important role in making decisions
SDM	Strive for an equal patient-physician relationship*	Paper hand-out sheet, interactive website, and summary sheet explicitly mention that the decision should be made according to the principles of SDM
	Facilitate patients in preference elicitation and values-clarification*	Paper hand-out sheet, interactive website and summary sheet contain components that facilitate conversation on the personal situation, wishes, and preferences of patients Paper hand-out sheet, interactive website, and summary sheet contain components that guide patients in values-clarification and preference-elicitation
	Explicitly communicate when the decision has to be made*	Paper hand-out sheet contains a flowchart of the advanced CKD care pathway Interactive website contains a chapter with information on all involved clinicians, and when the decision has to be made
	Explicitly communicate that the opinions and wishes of patients are important in the decision*	Paper hand-out sheet, interactive website, and summary sheet explicitly mention that the decision should be made according to the principles of SDM
	Do not try to “sell” any treatment modality, even if they have superior medical outcomes*	Paper hand-out sheet, interactive website, and summary sheet explicitly mention that the decision should be made according to the principles of SDM
Online PtDA	Exercise caution for “informational overload”*	Paper hand-out sheet contains elements that provide guidance on what chapters of the interactive website patients should focus on most Interactive website allows for easy navigation between chapters, saves patients’ location and answers when logging off, and provides the educational content in similarly structured chapters
	Strive for collaboration, and integrate everything on one platform*	PtDA has been developed in collaboration with key stakeholders and contains educational content of nieren.nl and nierwijzer.nl, both of which are owned by the Dutch kidney patient association and are endorsed by nephrology clinicians in the Netherlands
	Consider clinical practice when designing the PtDA*	PtDA has been developed for integration in established healthcare pathways without interfering with routine procedures
	Pay attention to health literacy and culture*	All components of the PtDA have been written in the B1 level of the CEFRL
Outcome information	Give patients autonomy in viewing outcome information*	Patients have to actively click through disclaimers before viewing survival probabilities and hospitalisation rates
	Provide tailored outcome information when possible*	Survival probabilities and hospitalisation rates have been stratified in age categories used by Dutch dialysis and kidney transplantation data registries
	Provide guidance on the interpretation of treatment outcomes*	Interactive website provides information on how patient characteristics impact treatment outcomes, and encourages conversations on treatment outcomes between patient and clinicians
	Pay attention to data visualization*	Outcome information has been visualised with infographics when possible

PtDA = Patient decision aid, SDM = Shared decision-making, CEFRL = Common European Framework of Reference for Languages. *Note: this is a translation from Dutch to English