Alternative explanation for results may exist

EDITOR—The results of Murray et al's two studies on interactive multimedia decision aids are compatible with the conclusions that both they 1 2 and the author of the accompanying editorial3 draw: that such products are generally acceptable; that they lead to a substantial decrease in patients' decisional conflict; that the interactive nature of the software allows information to be personalised; that high technology decision aids, though expensive now, are likely to cost less per case in the future; that it does not much matter that the technology was obsolete and the evidence had moved on by the time the papers were published; and that such technologies should be introduced more widely.

However, the results are also compatible with the opposite conclusion: that most patients prefer not to use (or even try out) multimedia decision support aids (hence the disappointingly low recruitment); that the absolute difference made to decisional conflict and to the actual decision made was small; that the interactivity provided only limited personalisation of the information for variables such as age and could not mirror the complexity of real life decision making; that the apparent acceptability and usefulness of multimedia decision aids might be explained by the Hawthorne effect of new technologies in educational contexts; and that the favourable economic evaluations presented failed to take into account the massive cost and lengthy time course of developing the …