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The state-of-the-art knowledge about the effectiveness of PtDAs to support people in making medical treatment or screening decisions is promising: an accumulating amount of research, including over 100 PtDAs studies across a variety of medical treatment and screening decisions, has showed that patient decision aids have been effective in improving people’s knowledge, feelings of being well-informed and clarity about their personal values. The evidence is less clear with regard to other outcomes, but it appears likely that people who have been exposed to PtDAs also have more accurate knowledge of the benefits and harms associated with medical options and have been more actively involved in the decision making process. Also, there is some evidence suggesting that PtDAs may help people to make choices that are congruent with their personal values and preferences, but more research is needed in this area. PtDAs do not have adverse effects on health outcomes or patient satisfaction. More research is needed to determine if PtDAs help people receive and adhere to their chosen option [16] and if this results in, for example, better well-being and quality of life. Even though the available evidence shows that the use of PtDAs has the potential to help people make better health decisions (in terms of better matching their values and preferences), more fine-grained understanding of the underlying processes is limited. Most studies so far have compared PtDAs to usual care rather than using a study design suitable to identify “active ingredients”. This limits the extent to which evidence-based guidance for designing effective PtDAs can be formulated. A theory-based approach can help to further the field. In the past, VCMs for example have often been designed without clearly being rooted in theory [25]. This may have hampered VCM effectiveness and complicated transparent and coherent, systematic design and evaluation. Where theory has been used, debate followed about the appropriateness of theory for the design of VCMs [e.g., 20,26]. Similarly, there is a gap in the evidence base for risk communication in the context of PtDAs. For example, it is still unclear how we can tailor risk communication in the context of eHealth and interactive tools to individual needs and abilities. What are optimal risk communication formats for vulnerable groups, including those with lower health literacy, numeracy and/or graph literacy? Rooting the design of PtDAs (including VCMs and risk communication) in theory and providing a clear rationale on how the theory has informed PtDAs design, enables targeted tests of the underlying mechanisms and may ultimately help to uncover the “active ingredients” of PtDAs. Addressing this gap will require systematic testing of different information formats within the same PtDA. 2.2. Challenges and opportunities of the boosting framework in the context of health decision support design and evaluation. Application of the boosting framework to personal health choices and the SDM process unveils new and promising horizons for future research and could inform the design and evaluation of health informatics interventions aimed at facilitating SDM, including PtDAs. In this section, we elaborate on the challenges and opportunities of the boosting framework in the context of health decision support design and evaluation. The main opportunities of using the boosting framework in this context are the guidance it can provide to design and test health informatics interventions that fit the way the human mind is wired, so that the interventions are likely to be more user-friendly, useful and effective–and therefore also more likely to be implemented and used sustainably. Implementation of PtDAs, and more broadly speaking of SDM, in everyday healthcare has so far been a major challenge [e.g., 2]. In a recent study [27] investigating M.deVriesetal. /FosteringSharedDecisionMakingwithHealth Informatics Interventions 117