Clarifying Values: An Updated and Expanded Systematic Review and Meta-Analysis

Abstract

BackgroundPatient decision aids should help people make evidence-informed decisions aligned with their values. There is limited guidance about how to achieve such alignment.PurposeTo 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 SourcesMEDLINE, EMBASE, PubMed, Web of Science, the Cochrane Library, CINAHLStudy SelectionWe included articles that described randomized trials of one or more explicit values clarification methods. From 30,648 records screened, we identified 33 articles describing trials of 43 values clarification methods.Data ExtractionTwo independent reviewers extracted details about each values clarification method and its evaluation.Data SynthesisCompared to control conditions or to implicit values clarification methods, explicit values clarification methods decreased the frequency of values-disgruent choices (risk difference -0.04 95% CI [-0.06 to -0.02], p<.001) and decisional regret (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 (Chi-squared(2)=9.25, p=.01). There were no differences between different values clarification methods regarding decisional conflict (Chi-squared(2)=6.08, p=.05).LimitationsSome meta-analyses had high heterogeneity. We grouped values clarification methods into broad categories.ConclusionsCurrent 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.

The International Patient Decision Aid Standards (IPDAS) Collaboration: Evidence Update 2.0

“…The articles in the IPDAS Update 2.0 series reflect the 11 broad domains. 1 – 13 Two of the broad domains published 2 articles: communicating probabilities about outcomes 3 , 4 and health literacy. 9 , 10 Other topics suggested for this update were theories and mechanisms, training in shared decision making, application of shared decision making in support of chronic conditions, whether or not to provide probabilities, and targeting specific disadvantaged populations.…”

“…In this article, we present IPDAS Evidence Update 2.0. The 13 articles that make up this update provide the latest evidence on 11 core IPDAS domains: development process, 1 providing balanced information, 2 communicating probabilities of outcomes, 3 , 4 clarifying values, 5 using personal stories, 6 guidance and decision coaching, 7 disclosing conflicts of interest, 8 health literacy, 9 , 10 basing information on scientific evidence, 11 measuring effectiveness, 12 and implementation of PtDAs. 13 …”

Study protocol for a randomised clinical trial of a decision aid and values clarification method for parents of a fetus or neonate diagnosed with a life-threatening congenital heart defect

“…Few studies have examined how effective values clarification methods, which the IPDAS standards collaborative added as criteria for decision aids, are when combined with a decision aid in clinical contexts. 26 Therefore, this study also aims to contribute to the literature by examining the effect of the decision aid with and without a values clarification method.…”

What Matters to Patients with Rheumatoid Arthritis When Facing Medical or Non-Medical Treatment Decisions?

“… 3 Sorting out what matters to a patient as relevant to a specific health treatment decision is an essential part of shared decision making and is known as “value clarification”. 4 In general, the theory of shared decision-making does not make a rigid demarcation between patient values and patient preferences. 5 According to Froberg and Kane, 6 patient preferences show the emphasis patients place on disease-related outcomes and include aspects of health, health care and other aspects that are important for the quality of life.…”

“…Value clarification is generally defined as the process of identifying what matters most to a patient when considering a given health treatment decision. 4 This process is not easy to perform. Patient may experience challenges in clarifying their values and preferences as these are not only health or care related, but also concerns personal life, such as daily activities, family and friends, finances, culture.…”