Background: “Implicit” values clarification is often used in patients' decision aids (PtDAs). For example, video-based PtDAs often present scenarios (i.e., “patient testimonials”) of various individuals describing their attitudes towards the pros and cons of different therapeutic options. The assumption is that this relatively non-interactive illustration helps viewers, by social matching, to clarify their own values. However, some patients may favor using more hands-on “explicit” values clarification exercises – i.e., the kinds of exercises that could be built into interactive PtDAs on electronic websites. A mismatch between the values clarification (VC) technique offered by a PtDA and the technique that a patient favors could confound attempts to help him/her form an authentic therapeutic preference.

Purpose: To compare patients' opinions about using implicit and explicit VC techniques in the design of a PtDA.

Methods: Because this was early developmental work, we asked healthy women to consider the hypothetical situation of a recent diagnosis with early-stage breast cancer. Power Point slides were used to present objective information about the surgical choice between mastectomy (with or without reconstruction) and lumpectomy with radiation. A participant was randomly allocated to either implicit Social Matching (SM) or an explicit Balance Technique (BT); at this point, she rated the technique in terms of its helpfulness, clarity, interest, and appropriateness for other patients. Next, she viewed and rated the alternative technique. Finally, the participant reported which technique she personally favored.

Results: Eleven women participated. Recruitment was stopped when a clear preference picture emerged, as follows.

a) Implicit vs. Explicit Groups' “Extremely/Yes” Ratings: Helpful = 1 (9%) vs 6 (55%); Clear = 6 (55%) vs 7 (64%); Interesting = 3 (28%) vs 7 (64%); Appropriate = 7 (64%) vs 10 (91%).

b) Overall Preferred Technique: 9 (82%) favored the BT, 1 (9%) the SM, and 1(9%) was indifferent between the two techniques.

Conclusions: At least in the context of early –stage breast cancer, the effort to incorporate explicit interactive VC techniques into future PtDAs would be worthwhile. Similar comparative studies could be carried out in other contexts. Then, subsequently, RCT designs could be used to test for the effects of matches/mismatches between the VC technique that a patient favors and the VC technique he or she actually encounters.