Participants also indicated that the language of the OPDG was sometimes negative and was not aligned with the approach or attitude towards decision making. Further, some participants stated that the language seemed to reflect the discrimination they often perceived in care settings. For instance, the statement that defined the results of test questions that screen for decisional conflict in Section 3 (the ‘SURE test’) was perceived as blaming the person using the form for not having enough certainty,knowledge, values, or support when decision making.Therefore, this statement was removed (‘People who answer “No” to one or more of these questions are more likely to delay their decision, change their mind, feel regret about their choice or to blame others for bad outcomes.’).The changes reflected preferences expressed by participants to avoid feeling that they were being directed in their decision making. Instead, participants indicated that
their preference was to participate in a self-directed process of decision making that supported a more familiar approach to problem solving. For instance Sarah said,“When I want something...need to get information, I have options, there is always a way...I can figure it out. I don’t need someone else telling me what I can’t do, don’t know”.