title: Clarifying values: an updated review.
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.
authors.forename: Angela
authors.initials: A
authors.lastname: Fagerlin
authors.forename: Michael
authors.initials: M
authors.lastname: Pignone
authors.forename: Purva
authors.initials: P
authors.lastname: Abhyankar
authors.forename: Nananda
authors.initials: N
authors.lastname: Col
authors.forename: Deb
authors.initials: D
authors.lastname: Feldman-Stewart
authors.forename: Teresa
authors.initials: T
authors.lastname: Gavaruzzi
authors.forename: Jennifer
authors.initials: J
authors.lastname: Kryworuchko
authors.forename: Carrie A
authors.initials: CA
authors.lastname: Levin
authors.forename: Arwen H
authors.initials: AH
authors.lastname: Pieterse
authors.forename: Valerie
authors.initials: V
authors.lastname: Reyna
authors.forename: Anne
authors.initials: A
authors.lastname: Stiggelbout
authors.forename: Laura D
authors.initials: LD
authors.lastname: Scherer
authors.forename: Celia
authors.initials: C
authors.lastname: Wills
authors.forename: Holly O
authors.initials: HO
authors.lastname: Witteman
mesh_terms: D003661:Decision Support Techniques; D006302:Health Services Research; D006801:Humans; D010358:Patient Participation; D057240:Patient Preference