Design and usability of heuristic-based deliberation tools for women facing amniocentesis

Background Evidence suggests that in decision contexts characterized by uncertainty and time constraints (e.g. health-care decisions), fast and frugal decision-making strategies (heuristics) may perform better than complex rules of reasoning. Objective To examine whether it is possible to design deliberation components in decision support interventions using simple models (fast and frugal heuristics). Design The ‘Take The Best’ heuristic (i.e. selection of a ‘most important reason’) and ‘The Tallying’ integration algorithm (i.e. unitary weighing of pros and cons) were used to develop two deliberation components embedded in a Web-based decision support intervention for women facing amniocentesis testing. Ten researchers (recruited from 15), nine health-care providers (recruited from 28) and ten pregnant women (recruited from 14) who had recently been offered amniocentesis testing appraised evolving versions of ‘your most important reason’ (Take The Best) and ‘weighing it up’ (Tallying). Results Most researchers found the tools useful in facilitating decision making although emphasized the need for simple instructions and clear layouts. Health-care providers however expressed concerns regarding the usability and clarity of the tools. By contrast, 7 out of 10 pregnant women found the tools useful in weighing up the pros and cons of each option, helpful in structuring and clarifying their thoughts and visualizing their decision efforts. Several pregnant women felt that ‘weighing it up’ and ‘your most important reason’ were not appropriate when facing such a difficult and emotional decision. Conclusion Theoretical approaches based on fast and frugal heuristics can be used to develop deliberation tools that provide helpful support to patients facing real-world decisions about amniocentesis