Prioritizing Equity in Design and Implementation of Consumer-Facing Digital Resources to Support Engagement and...

A digitally enabled health system offers the opportunity to address gaps in the implementation of shared decision-making, a collaborative process between health professionals and consumers to decide on the best test, treatment, or management option based on clinical evidence and the consumer's values and informed preferences. There is increasing design and availability of digital tools online to support shared decision-making. Providing opportunities for all consumers to make shared health care decisions is not only key to achieving safer, higher-quality health care, but also an ethical and social imperative that upholds the fundamental rights of every health care consumer. However, there is a risk that digital tools intended to support shared decision-making might worsen inequities in access to and use of health information. In this Viewpoint, we use the case study of digital decision aids to argue that equity should be proactively prioritized as these tools are increasingly designed, accessed, and adopted. We highlight the need for digital health researchers and organizations to (1) address health literacy and accessibility by design, (2) meaningfully co-design tools with underrepresented end users, and (3) generate evidence among underrepresented end users on how emerging digital decision aid features with potential for meeting more diverse needs (eg, interactivity, tailoring, and AI) impact decision-making outcomes. We summarize the current gaps in addressing these recommendations in the development of digital decision aids. Regarding implementation, we also urge policymakers advocating for consumer engagement in health decisions to invest in (1) national, standardized online portals that streamline and enhance consumer and clinician access to co-designed digital decision aids that meet the needs of users with varying levels of health literacy and (2) digital inclusion initiatives that ensure equitable access and adoption of digital tools to support shared decision-making.