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

Overview

Journal Med Decis Making

Publisher Sage Publications

Date 2010 May 21

PMID 20484089

Citations 20

Authors

Stacey L Sheridan

Jennifer M Griffith

Lindy Behrend

Ziya Gizlice

Jianwen Cai

Michael P Pignone

Affiliations

Soon will be listed here.

Abstract

Background: Experts have called for the inclusion of values clarification (VC) exercises in decision aids (DAs) 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 to 80 with no history of cardiovascular disease.

Intervention: A Web-based heart disease prevention DA with or without a VC exercise.

Measurements: Pre- and postintervention decisional conflict and intent to reduce coronary heart disease (CHD) risk and postintervention self-efficacy and perceived values concordance.

Results: The authors enrolled 137 participants (62 in DA; 75 in DA + VC with moderate decisional conflict (DA 2.4; DA + VC 2.5) and no baseline differences among groups. After the interventions, they found no clinically or statistically significant differences between groups in decisional conflict (DA 1.8; DA + VC 1.9; absolute difference VC-DA 0.1, 95% confidence interval [CI]: -0.1 to 0.3), intent to reduce CHD risk (DA 98%; DA + VC 100%; absolute difference VC-DA: 2%, 95% CI: -0.02% to 5%), perceived values concordance (DA 95%; DA + VC 92%; absolute difference VC-DA -3%, 95% CI: -11% to +5%), or self-efficacy for risk reduction (DA 97%; DA + VC 92%; absolute difference VC-DA -5%, 95% CI: -13% to +3%). However, DA + 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.

Citing Articles

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Gultzow T, Smit E, Crutzen R, Jolani S, Hoving C, Dirksen C J Med Internet Res. 2022; 24(7):e34246.

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Hazlewood G, Marshall D, Barber C, Li L, Barnabe C, Bykerk V Patient Prefer Adherence. 2020; 14:829-838.

PMID: 32546977 PMC: 7244245. DOI: 10.2147/PPA.S221897.

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