Clarifying Values: An Updated and Expanded Systematic Review and Meta-Analysis
Medical Decision Making, vol. 41, pp. 801–820
Abstract
Background Patient decision aids should help people make evidence-informed decisions aligned with their values. There is limited guidance about how to achieve such alignment. Purpose To describe the range of values clarification methods available to patient decision aid developers, synthesize evidence regarding their relative merits, and foster collection of evidence by offering researchers a proposed set of outcomes to report when evaluating the effects of values clarification methods. Data Sources MEDLINE, EMBASE, PubMed, Web of Science, the Cochrane Library, and CINAHL. Study Selection We included articles that described randomized trials of 1 or more explicit values clarification methods. From 30,648 records screened, we identified 33 articles describing trials of 43 values clarification methods. Data Extraction Two independent reviewers extracted details about each values clarification method and its evaluation. Data Synthesis Compared to control conditions or to implicit values clarification methods, explicit values clarification methods decreased the frequency of values-incongruent choices (risk difference, –0.04; 95% confidence interval [CI], –0.06 to –0.02; P < 0.001) and decisional conflict (standardized mean difference, –0.20; 95% CI, –0.29 to –0.11; P < 0.001). Multicriteria decision analysis led to more values-congruent decisions than other values clarification methods (χ 2 = 9.25, P = 0.01). There were no differences between different values clarification methods regarding decisional conflict (χ 2 = 6.08, P = 0.05). Limitations Some meta-analyses had high heterogeneity. We grouped values clarification methods into broad categories. Conclusions Current evidence suggests patient decision aids should include an explicit values clarification method. Developers may wish to specifically consider multicriteria decision analysis. Future evaluations of values clarification methods should report their effects on decisional conflict, decisions made, values congruence, and decisional regret.
Authors 21
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Holly O. Witteman corresponding
Université Laval · Quebec Research and Development Centre
Affiliation as printed
CHU de Québec Research Centre, Quebec City, Quebec, Canada
Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
VITAM Research Centre, Quebec City, Quebec, Canada
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Affiliation as printed
Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
VITAM Research Centre, Quebec City, Quebec, Canada
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Université Laval · Quebec Research and Development Centre
Affiliation as printed
CHU de Québec Research Centre, Quebec City, Quebec, Canada
Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
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Affiliation as printed
Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
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University of Pittsburgh · UPMC Health System · University of Pittsburgh Medical Center
Affiliation as printed
UPMC Palliative and Supportive Institute, Division of General Internal Medicine, Section of Palliative Care and Medical Ethics, University of Pittsburgh, Pittsburgh, PA, USA
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Affiliation as printed
Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH, USA
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Affiliation as printed
Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
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Affiliation as printed
Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT, USA
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Affiliation as printed
Department of Developmental Psychology and Socialization, University of Padova, Padova, Italy
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Affiliation as printed
Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
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Arwen H. Pieterse Aachen
Leiden University Medical Center
Affiliation as printed
Leiden University Medical Center, Leiden, The Netherlands
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The University of Texas at Austin
Affiliation as printed
Departments of Internal Medicine and Population Health, Dell Medical School, University of Texas, Austin, TX, USA
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Affiliation as printed
Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
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Affiliation as printed
Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
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University of British Columbia
Affiliation as printed
School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
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Affiliation as printed
Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
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Affiliation as printed
School of Health and Related Research, University of Sheffield, Sheffield, UK
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Affiliation as printed
Municipal Health Services (GGD), Enschede, The Netherlands
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Affiliation as printed
Program on Ethics and Decision Making in Critical Illness, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Affiliation as printed
College of Nursing, Center on Healthy Aging, Self-Management and Complex Care, The Ohio State University, Columbus, OH, USA
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Maastricht University · Care and Public Health Research Institute
Affiliation as printed
Department of Family Medicine/CAPHRI, Maastricht University, Maastricht, The Netherlands
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