Abstract
AbstractBackgroundPatient 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.
Publisher
Cold Spring Harbor Laboratory