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Appears in Collections:Faculty of Health Sciences and Sport Journal Articles
Peer Review Status: Refereed
Title: Clarifying Values: An updated review
Authors: Fagerlin, Angela
Pignone, Michael
Abhyankar, Purva
Col, Nananda
Feldman-Stewart, Deb
Gavaruzzi, Teresa
Kryworuchko, Jennifer
Levin, Carrie A
Pieterse, Arwen
Reyna, Valerie
Stiggelbout, Anne
Scherer, Laura D
Wills, Celia
Witteman, Holly
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Issue Date: 29-Nov-2013
Publisher: BioMed Central Ltd
Citation: Fagerlin A, Pignone M, Abhyankar P, Col N, Feldman-Stewart D, Gavaruzzi T, Kryworuchko J, Levin CA, Pieterse A, Reyna V, Stiggelbout A, Scherer LD, Wills C & Witteman H (2013) Clarifying Values: An updated review, BMC Medical Informatics and Decision Making, 13 (Suppl 2), Art. No.: S8.
Abstract: Background: Consensus guidelines have recommended that decision aids include a process for helping patients clarify their values. We sought to examine the theoretical and empirical evidence related to the use of values clarification methods in patient decision aids. Methods: Building on the International Patient Decision Aid Standards (IPDAS) Collaboration's 2005 review of values clarification methods in decision aids, we convened a multi-disciplinary expert group to examine key definitions, decision-making process theories, and empirical evidence about the effects of values clarification methods in decision aids. To summarize the current state of theory and evidence about the role of values clarification methods in decision aids, we undertook a process of evidence review and summary. Results: Values clarification methods (VCMs) are best defined as methods to help patients think about the desirability of options or attributes of options within a specific decision context, in order to identify which option he/she prefers. Several decision making process theories were identified that can inform the design of values clarification methods, but no single "best" practice for how such methods should be constructed was determined. Our evidence review found that existing VCMs were used for a variety of different decisions, rarely referenced underlying theory for their design, but generally were well described in regard to their development process. Listing the pros and cons of a decision was the most common method used. The 13 trials that compared decision support with or without VCMs reached mixed results: some found that VCMs improved some decision-making processes, while others found no effect. Conclusions: Values clarification methods may improve decision-making processes and potentially more distal outcomes. However, the small number of evaluations of VCMs and, where evaluations exist, the heterogeneity in outcome measures makes it difficult to determine their overall effectiveness or the specific characteristics that increase effectiveness.
Type: Journal Article
DOI Link:
Rights: © 2013 Fagerlin et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Affiliation: University of Michigan
University of North Carolina
NMAHP Research
University of New England
Queen's University, Ontario
University of Padova
University of Saskatchewan
Informed Medical Decisions Foundation, Boston, MA
Leiden University Medical Center
Cornell University
Leiden University Medical Center
University of Missouri - Columbia
University of Missouri - Columbia
Ohio State University
University of Michigan

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