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81 Decision aid development and usability testing 4 Adapting an existing tool to a (culturally) different setting and adjusting it to local circumstances seems a useful alternative to an entirely new development process. This could free resources to focus on other important aspects like DA implementation. Practice implications The process of developing and testing the DA as described in this paper could be applied to the (cultural) adaptation of other pre-existing tools to different languages and clinical settings. As it enhances focus on usability and fit with clinical practice, it could be a fruitful step to improve implementation of decision aids in routine clinical care.