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

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 (χ2 = 9.25, P = 0.01). There were no differences between different values clarification methods regarding decisional conflict (χ2 = 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.

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

10.1101/2021.01.21.21250270 ◽

2021 ◽

Author(s):

Holly O. Witteman ◽

Ruth Ndjaboue ◽

Gratianne Vaisson ◽

Selma Chipenda Dansokho ◽

Bob Arnold ◽

...

Keyword(s):

Decision Analysis ◽

Decision Aids ◽

Decisional Conflict ◽

Multicriteria Decision Analysis ◽

Values Clarification ◽

Patient Decision Aids ◽

Multicriteria Decision ◽

Patient Decision ◽

Chi Squared ◽

Decisional Regret

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.

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Delivering patient decision aids on the Internet: definitions, theories, current evidence, and emerging research areas

BMC Medical Informatics and Decision Making ◽

10.1186/1472-6947-13-s2-s13 ◽

2013 ◽

Vol 13 (S2) ◽

Cited By ~ 55

Author(s):

Aubri S Hoffman ◽

Robert J Volk ◽

Anton Saarimaki ◽

Christine Stirling ◽

Linda C Li ◽

...

Keyword(s):

Decision Aids ◽

Current Evidence ◽

The Internet ◽

Patient Decision Aids ◽

Research Areas ◽

Patient Decision

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On the suitability of fast and frugal heuristics for designing values clarification methods in patient decision aids: a critical analysis

Health Expectations ◽

10.1111/j.1369-7625.2011.00720.x ◽

2011 ◽

Vol 16 (3) ◽

pp. e73-e79 ◽

Cited By ~ 10

Author(s):

Arwen H. Pieterse ◽

Marieke de Vries

Keyword(s):

Critical Analysis ◽

Decision Aids ◽

Values Clarification ◽

Patient Decision Aids ◽

Fast And Frugal Heuristics ◽

Patient Decision

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Go to the Hospital or Stay Here?: A Randomized Clinical Trial

Innovation in Aging ◽

10.1093/geroni/igaa057.2742 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 760-760

Author(s):

Sarah Worch ◽

Ruth Tappen

Keyword(s):

Clinical Trial ◽

Decision Aid ◽

Long Term Care ◽

Decision Aids ◽

Decisional Conflict ◽

Term Care ◽

Patient Decision Aids ◽

Patient Decision ◽

Initial Clinical Trial

Abstract With the exception of guides for making end of life choices, there are very few if any patient decision aids created for residents of long-term care facilities. Further, only half of patient decision aids produced for any purpose have actually been field tested with patients and even fewer have been evaluated by providers other than the developers of the decision aid. Development of Go to the Hospital or Stay Here? was based on expert experience combined with extensive input from over 270 long-term care residents, their families and their caregivers. The initial clinical trial of this decision aid is reported in this presentation. Increased knowledge, reduced decisional conflict, increased preference for care in the nursing home when possible and a high rating of the helpfulness of the Guide were found in those who received the Guide (n=97) compared to those who did not (n=95).

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Current Best Practice for Presenting Probabilities in Patient Decision Aids: Fundamental Principles

Medical Decision Making ◽

10.1177/0272989x21996328 ◽

2021 ◽

pp. 0272989X2199632

Author(s):

Carissa Bonner ◽

Lyndal J. Trevena ◽

Wolfgang Gaissmaier ◽

Paul K. J. Han ◽

Yasmina Okan ◽

...

Keyword(s):

Science Communication ◽

Best Practice ◽

Decision Aids ◽

Relevant Literature ◽

The United States ◽

Knowledge Bases ◽

Current Evidence ◽

Patient Decision Aids ◽

Patient Decision ◽

User Skills

Background Shared decision making requires evidence to be conveyed to the patient in a way they can easily understand and compare. Patient decision aids facilitate this process. This article reviews the current evidence for how to present numerical probabilities within patient decision aids. Methods Following the 2013 review method, we assembled a group of 9 international experts on risk communication across Australia, Germany, the Netherlands, the United Kingdom, and the United States. We expanded the topics covered in the first review to reflect emerging areas of research. Groups of 2 to 3 authors reviewed the relevant literature based on their expertise and wrote each section before review by the full authorship team. Results Of 10 topics identified, we present 5 fundamental issues in this article. Although some topics resulted in clear guidance (presenting the chance an event will occur, addressing numerical skills), other topics (context/evaluative labels, conveying uncertainty, risk over time) continue to have evolving knowledge bases. We recommend presenting numbers over a set time period with a clear denominator, using consistent formats between outcomes and interventions to enable unbiased comparisons, and interpreting the numbers for the reader to meet the needs of varying numeracy. Discussion Understanding how different numerical formats can bias risk perception will help decision aid developers communicate risks in a balanced, comprehensible manner and avoid accidental “nudging” toward a particular option. Decisions between probability formats need to consider the available evidence and user skills. The review may be useful for other areas of science communication in which unbiased presentation of probabilities is important.

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Do Personal Stories Make Patient Decision Aids More Effective? An Update from the International Patient Decision Aids Standards

Medical Decision Making ◽

10.1177/0272989x211011100 ◽

2021 ◽

pp. 0272989X2110111

Author(s):

Victoria A. Shaffer ◽

Suzanne Brodney ◽

Teresa Gavaruzzi ◽

Yaara Zisman Ilani ◽

Sarah Munro ◽

...

Keyword(s):

Decision Aids ◽

Relevant Literature ◽

Empirical Work ◽

Theoretical Work ◽

Decisional Conflict ◽

Bottom Line ◽

Patient Decision Aids ◽

Patient Narratives ◽

Patient Decision ◽

The Impact

Background This article evaluates the evidence for the inclusion of patient narratives in patient decision aids (PtDAs). We define patient narratives as stories, testimonials, or anecdotes that provide illustrative examples of the experiences of others that are relevant to the decision at hand. Method To evaluate the evidence for the effectiveness of narratives in PtDAs, we conducted a narrative scoping review of the literature from January 2013 through June 2019 to identify relevant literature published since the last International Patient Decision Aid Standards (IPDAS) update in 2013. We considered research articles that examined the impact of narratives on relevant outcomes or described relevant theoretical mechanisms. Results The majority of the empirical work on narratives did not measure concepts that are typically found in the PtDA literature (e.g., decisional conflict). Yet, a few themes emerged from our review that can be applied to the PtDA context, including the impact of narratives on relevant outcomes (knowledge, behavior change, and psychological constructs), as well as several theoretical mechanisms about how and why narratives work that can be applied to the PtDA context. Conclusion Based on this evidence update, we suggest that there may be situations when narratives could enhance the effectiveness of PtDAs. The recent theoretical work on narratives has underscored the fact that narratives are a multifaceted construct and should no longer be considered a binary option (include narratives or not). However, the bottom line is that the evidence does not support a recommendation for narratives to be a necessary component of PtDAs.

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