Background Mild cognitive impairment (MCI) is often considered a transitional state between normal and pathologic (eg, dementia) cognitive aging. Although its prognosis varies largely, the diagnosis carries the risk of causing uncertainty and overtreatment of older adults with MCI who may never progress to dementia. Decision aids help people become better informed and more involved in decision making by providing evidence-based information about options and possible outcomes and by assisting them in clarifying their personal values in relation to the decision to be made. Objective This study aimed to incorporate features that best support values clarification and adjust the level of detail of a web-based decision aid for individuals with MCI. Methods We conducted a rapid review to identify options to maintain or improve cognitive functions in individuals with MCI. The evidence was structured into a novel web-based decision aid designed in collaboration with digital specialists and graphic designers. Qualitative and user-centered evaluations were used to draw on users’ knowledge, clarify values, and inform potential adoption in routine clinical practice. We invited clinicians, older adults with MCI, and their caregivers to evaluate the decision aid in 6 consecutive rounds, with new participants in each round. Quantitative data were collected using the Values Clarity and Informed subscales of the Decisional Conflict Scale, the System Usability Scale, the Ottawa Acceptability questionnaire, and a 5-point satisfaction rating scale. We verified their comprehension using a teach-back method and recorded usability issues. We recorded the audio and computer screen during the session. An inductive thematic qualitative analysis approach was used to identify and describe the issues that arose. After each round, an expert panel met to prioritize and find solutions to mitigate the issues. An integrated analysis was conducted to confirm our choices. Results A total of 7 clinicians (social workers, nurses, family physicians, psychologists) and 12 older (≥60 years) community-dwelling individuals with MCI, half of them women, with education levels going from none to university diploma, were recruited and completed testing. The thematic analysis revealed 3 major issues. First, the user should be guided through the decision-making process by tailoring the presentation of options to users’ priorities using the values clarification exercise. Second, its content should be simple, but not simplistic, notably by using information layering, plain language, and pictograms. Third, the interface should be intuitive and user friendly, utilize pop-up windows and information tips, avoid drop-down menus, and limit the need to scroll down. The quantitative assessments corroborated the qualitative findings. Conclusions This project resulted in a promising web-based decision aid that can support decision making for MCI intervention, based on the personal values and preferences of the users. Further ongoing research will allow its implementation to be tested in clinical settings.

Introduction: Implementation of shared decision making (SDM) remains a challenge. To support implementation studies, we sought to develop and validate the IcanSDM scale that assesses clinicians' perceptions of their ability to adopt SDM. Methods: An expert panel reviewed the literature on clinician-reported barriers to SDM adoption, to create an 11-item preliminary scale. A convenience sample of 16 clinicians from Quebec (Canada) completed the IcanSDM and the Belief about Capabilities subscale of the CPD-Reaction instrument (BCap), before and after SDM training. We audio-recorded their comments as they completed the scale. We measured IcanSDM's internal consistency, sensitivity to change and correlation with BCap. Partial correlation coefficients and item analyses suggested removing three items. We then tested the 8-item IcanSDM with a new sample of 17 clinicians. Results: In the 11-item IcanSDM version, three items lacked clarity or responsiveness, or showed negative partial correlations with the whole instrument. We thus removed these items. The revised 8-item version gave Cronbach's alphas of 0.63 before and 0.71 after training, and a 16% improvement in IcanSDM total score after training, compared to before training (p<0.0001). We also found a significant correlation between IcanSDM and the BCap before training (p=0.02), but not after (p=0.46). Discussion: IcanSDM is the only instrument measuring this construct. It could thus help bridge the gap in our ability to understand the determinants of clinicians' SDM behavior intentions and thus help improve SDM implementation impacts and efforts. IcanSDM requires testing with a larger sample to confirm its responsiveness.

Objective: To support studies on the implementation of shared decision making (SDM), we sought to develop and validate the IcanSDM scale that assesses clinicians’ perceptions of their ability to adopt SDM. Results : An expert panel reviewed the literature on clinician-reported barriers to SDM adoption, to create an 11-item preliminary scale. A convenience sample of 16 clinicians from Québec (Canada) completed the IcanSDM and the Belief about capabilities subscale of the CPD-Reaction instrument (BCap), before and after SDM training. We audio-recorded their comments as they completed the scale. We measured IcanSDM’s internal consistency, sensitivity to change and correlation with BCap. Partial correlation coefficients and item analyses suggested removing three items. In the 11-item IcanSDM version, three items lacked clarity or responsiveness, or showed negative partial correlations with the whole instrument. We thus removed these items. The revised 8-item version gave Cronbach’s alphas of 0.63 before and 0.71 after training, and a 16% improvement in IcanSDM total score after training, compared to before training (p<0.0001). We also found a significant correlation between IcanSDM and the BCap before training (p=0.02), but not after (p=0.46).

La transition à la parentalité peut susciter plusieurs défis. La famille fonctionnant selon un modèle écosystémique, l’anxiété d’un parent a le potentiel d’influencer le vécu de l’autre. Toutefois, l’expérience de la parentalité avec un coparent anxieux et les conséquences de l’anxiété sur soi, le couple et la famille demeurent méconnues. Ce projet pilote vise à comprendre le vécu des pères et des mères vivant avec un coparent anxieux lors de la transition à la parentalité. Vingt-sept parents (12 pères et 15 mères) vivant une grossesse ou ayant un enfant de moins de deux ans ont répondu à un questionnaire en ligne sondant leur expérience par des questions ouvertes. Les répondant.es identifient diverses sources d’anxiété pour des pères et des mères. Cependant, un consensus émerge quant aux conséquences généralement négatives de l’anxiété du coparent pour eux, leur couple et leur famille. Leurs propos suggèrent une séquence temporelle type plutôt que des profils distincts. Après avoir initialement adopté un rôle de soutien, ils développent des émotions, cognitions et comportements négatifs. Des recherches futures devraient investiguer les conséquences individuelles, conjugales et familiales de l’anxiété d’un coparent, autant chez des mères que des pères, et examiner si la fatigue de compassion explique leur expérience.

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