title: 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 (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.
  
  
  METHODS
  Randomized trial.
  
  
  METHODS
  UNC Decision Support Laboratory.
  
  
  METHODS
  Adults ages 40 to 80 with no history of cardiovascular disease.
  
  
  METHODS
  A Web-based heart disease prevention DA with or without a VC exercise.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of General Medicine and Clinical Epidemiology, University of North Carolina, Chapel Hill, 27599, USA. sls593@med.unc.edu
authors.forename: Stacey L
authors.initials: SL
authors.lastname: Sheridan
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Griffith
authors.forename: Lindy
authors.initials: L
authors.lastname: Behrend
authors.forename: Ziya
authors.initials: Z
authors.lastname: Gizlice
authors.lastname: Jianwen Cai
authors.forename: Michael P
authors.initials: MP
authors.lastname: Pignone
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003657:Decision Making; D005260:Female; D006331:Heart Diseases / Q000517:prevention & control*; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged