User-centred design and development of a patient decision aid for choice of first trimester abortion method

Abstract

Objectives Following the 2017 introduction of mifepristone medical abortion in Canada, we developed a patient decision aid (PDA) to support informed, values-based choice between medical and surgical care for first trimester abortion. Methods We used the International PDA Standards Collaboration process to develop a prototype based on Canadian clinical practice guidelines. We integrated written feedback from experts, then conducted two phases of user testing involving 30-60 minute interviews and the System Usability Scale (SUS) questionnaire. Interviews were subjected to thematic analysis; results were used to iteratively revise the PDA. Results Expert review by 3 obstetricians-gynecologists, 3 family physicians, 1 registered nurse, and 1 risk communication expert resulted in improved descriptions of abortion methods and experiences. Initial user testing included 7 community members who were 31-37 years old, Hispanic, Black, Chinese, Southeast Asian, or White, college or university educated, and parous. The median SUS score was 89.06 (excellent usability); changes included shortened format, resources links, and updates of user-important attributes (e.g., pain, travel time). Subsequent testing included 4 patients with a history of abortion who were 26-38 years old, White, and college or university educated. The median SUS score was 98.75 and changes included support to find an abortion provider and personalized information based on contraindications and values. Conclusions The final PDA is an interactive website designed to enable women in Canada to understand and make decisions about method of early abortion, in partnership with their healthcare provider. Access to this evidence-based, user-preferred PDA may enable efficient and patient-centred communication about early abortion options.