Effect of Adding a Values Clarification Exercise to a Decision Aid on Heart Disease Prevention: A Randomized Trial

Abstract

Background Experts have called for the inclusion of values clarification (VC) exercises in decision aids (DA) as a means of improving their effectiveness, but little research has examined the effects of such exercises. Objective To determine whether adding a VC exercise to a DA on heart disease prevention improves decision making outcomes. Design Randomized trial. Setting UNC Decision Support Laboratory. Patients Adults ages 40–80 with no history of cardiovascular disease. Intervention A web-based heart disease prevention DA with or without a VC exercise. Measurements Pre and post-intervention decisional conflict and intent to reduce CHD risk. Post-intervention self-efficacy and perceived values concordance. Results We enrolled 137 participants (62 in DA; 75 in VC) with moderate decisional conflict (DA 2.4; VC 2.5) and no baseline differences among groups. After the interventions, we found no clinically or statistically significant differences between groups in decisional conflict (DA 1.8; VC 1.9; absolute difference VC-DA 0.1, 95% CI −0.1 to 0.3), intent to reduce CHD risk (DA 98%; VC 100%; absolute differences VC-DA: 2%, 95% CI −0.02% to 5%), perceived values concordance (DA 95%, VC 92%; absolute difference VC-DA −3%, 95% CI −11 to +5%), or self efficacy for risk reduction (DA 97%, VC 92%; absolute difference VC-DA −5%, 95% CI −13 to +3%). However, VC tended to change some decisions about risk reduction strategies. Limitations Use of a hypothetical scenario. Ceiling effects for some outcomes. Conclusions Adding a VC intervention to a DA did not further improve decision making outcomes in a population of highly educated and motivated adults responding to scenario-based questions. Work is needed to determine the effects of VC on more diverse populations and more distal outcomes.

A randomized trial of an intervention to improve use and adherence to effective coronary heart disease prevention strategies

“…Investigators pilot-tested a previous version of the decision aid [26] and studied its effects with and without the values clarification section [25]. The coaching portion has not been independently described or tested; a more detailed description is provided in Additional File 1.…”

Development of a Decision Aid about fertility preservation for women with breast cancer in the Netherlands

“…More recent studies found that explicit VCEs lead to more satisfaction with preparation for decision making [26] and lower decisional conflict [27]. However, some studies did not find significant improvements in decision making when adding an explicit VCE to a DA [28].…”

Decisional outcomes following use of an interactive web-based decision aid for prostate cancer screening

“…The Science Panel on Interactive Communication and Health noted the benefits of interactive elements in health communication by helping individuals better understand their health-related values and decisions in an engaging way [42]. Though a recent paper has found no direct benefit of using a values clarification tool for heart disease-related decision making [43], several recent studies in cancer-related decision making have found that both breast cancer and PCa patients have better outcomes, such as less decisional conflict, when using media with interactive elements versus informational materials with no interactivity [28,[31][32][33]. Additionally, a recent paper assessing participants' use of a web-based smoking cessation tool found that increased use of interactive website features and more frequent use of the website contributed to sustained smoking cessation [34].…”