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usage of a patient decision aid, observing a sample of more than 1000 patients diagnosed with prostate cancer, only about one in three eligible patients received a link to an online patient decision aid. Those who did receive a link to the decision aid, typically also accessed the decision aid online, utilized most of its content and functions, and discussed the decision aid summary in a follow-up consultation with their health care provider. Even though the overall implementation rate was low in this study, a wide variation in implementation rate (16-84%) was observed between hospitals. Even though the boosting framework may not be sufficient in overcoming the implementation challenge, it may provide some useful opportunities. The main challenges of using the boosting framework in the context of fostering personal health choices and SDM with health informatics interventions, may very well exist in implicit or explicit resistance to adopting new roles in the patient/clinician encounter, on the part of patients as well as healthcare providers. For example, many patients do not dare to voice their preferences, needs or concerns, out of fear of being labelled a “difficult” patient [e.g., 28]. Healthcare providers may mistakenly assume that their patients do not want to or are not able to take a more active role, but research shows the contrary [18]. Healthcare providers may also have false beliefs about the amount of extra time needed for SDM: Even though the effect of using PtDAs on consultation length is typically about 2 to 3 minutes [16], the belief that SDM is too time consuming is one of the main clinician-reported barriers to implementing SDM in everyday clinical practice[29]. The boosting framework can help shed light on promising avenues for future research. Ultimately, the aim of SDM is to help patients and caregivers make well- informed decisions in collaboration with the health care provider and aligning with what matters most from the patient’s perspective. Whereas it is by now well established that PtDAs can help (“boost”) people’s competences to understand the medical information relevant to the medical choice they are facing and to clarify their personal values, far less is known about how to help people implement their preferences in everyday healthcare. We believe the vision behind the boosting framework unveils new and promising horizons for future research. Boosting is focused on competences people need to make better decisions when they face a challenging decision. Competences that have so far been “boosted” in the field of SDM-focused health informatics, are mainly related to understanding (risk) information and values clarification. In the clinical encounter, where patients and healthcare providers implement the final health decisions, other crucial competences are at play as well, which may very well lie on the social, interpersonal dimension. For example, certain decisions may mean deviating from clinical guidelines and this requires courage, trust and tolerance of uncertainty [e.g., 30]. If the ultimate aim is to empower people so that they can make choices which result in tailored care that truly aligns with what matters most to them, we may therefore need to shift gears, broaden the scope and focus on boosting those other competences that may very well be crucial in driving the ultimate SDM behaviour in the clinical encounter. M.deVriesetal. /FosteringSharedDecisionMakingwithHealth Informatics Interventions118