Clarifying values: an updated review |
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| Authors: | Angela Fagerlin Michael Pignone Purva Abhyankar Nananda Col Deb Feldman-Stewart Teresa Gavaruzzi Jennifer Kryworuchko Carrie A Levin Arwen H Pieterse Valerie Reyna Anne Stiggelbout Laura D Scherer Celia Wills Holly O Witteman |
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| Affiliation: | 1.Department of Internal Medicine and Center for Bioethics and Social Sciences in Medicine,University of Michigan and VA Ann Arbor Center for Clinical Management Research,Ann Arbor,USA;2.Department of Medicine and Cecil Sheps Center for Health Services Research, CB# 7110,University of North Carolina,Chapel Hill,USA;3.Nursing, Midwifery and Allied Health Professions Research Unit,University of Stirling,Stirling,UK;4.Departments of Family Medicine and Geriatric Medicine, College of Osteopathic Medicine and Center for Excellence in the Neurosciences,University of New England,Biddeford,USA;5.Division of Cancer Care and Epidemiology, Cancer Research Institute, Department of Oncology,Queen’s University,Kingston,Canada;6.Department of Developmental Psychology and Socialization,University of Padova (Italy),Padova,Italy;7.Leeds Institute of Health Sciences, Charles Thackrah Building,University of Leeds,Leeds,England;8.University of Saskatchewan College of Nursing,St. Andrew’s College,Saskatoon,Canada;9.Informed Medical Decisions Foundation,Boston,USA;10.Department of Medical Decision Making,Leiden University Medical Center,The Netherlands;11.Center for Behavioral Economics and Decision Research and Cornell Magnetic Resonance Imaging Facility,Cornell University MVR B44,Ithaca,USA;12.Department of Medical Decision Making,Leiden University Medical Center,The Netherlands;13.Department of Psychological Sciences,University of Missouri-Columbia,Columbia,USA;14.The Ohio State University College of Nursing,Columbus,USA;15.Office of Education & Continuing Professional Development and Department of Family and Emergency Medicine,Université Laval, Pavillon Ferdinand-Vandry,Quebec City,Canada |
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| Abstract: | BackgroundConsensus guidelines have recommended that decision aids include a process for helping patients clarify their values. We sought to examine the theoretical and empirical evidence related to the use of values clarification methods in patient decision aids.MethodsBuilding on the International Patient Decision Aid Standards (IPDAS) Collaboration’s 2005 review of values clarification methods in decision aids, we convened a multi-disciplinary expert group to examine key definitions, decision-making process theories, and empirical evidence about the effects of values clarification methods in decision aids. To summarize the current state of theory and evidence about the role of values clarification methods in decision aids, we undertook a process of evidence review and summary.ResultsValues clarification methods (VCMs) are best defined as methods to help patients think about the desirability of options or attributes of options within a specific decision context, in order to identify which option he/she prefers. Several decision making process theories were identified that can inform the design of values clarification methods, but no single “best” practice for how such methods should be constructed was determined. Our evidence review found that existing VCMs were used for a variety of different decisions, rarely referenced underlying theory for their design, but generally were well described in regard to their development process. Listing the pros and cons of a decision was the most common method used. The 13 trials that compared decision support with or without VCMs reached mixed results: some found that VCMs improved some decision-making processes, while others found no effect.ConclusionsValues clarification methods may improve decision-making processes and potentially more distal outcomes. However, the small number of evaluations of VCMs and, where evaluations exist, the heterogeneity in outcome measures makes it difficult to determine their overall effectiveness or the specific characteristics that increase effectiveness. |
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