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Methods: We tested the effect of a heart disease prevention decision aid alone (DA) or in combination with a values clarification exercise (VC) exercise in a convenience sample of men and women, ages 40-80, with no prior history of cardiovascular disease. After completing a baseline questionnaire, participants were randomized to either the DA or VC groups. Participants in each group worked through a web-based decision aid using a combination of personal and hypothetical information about CHD risk factors. Participants in the VC arm then completed a web-based values clarification exercise in which they weighed and ordered the importance of five features of CHD prevention strategies. All participants completed a post-intervention questionnaire to capture changes in decisional conflict, intent to reduce their CHD risk, and self-efficacy for chosen risk reduction strategies; and to determine whether they felt they made a decision consistent with their values.
Results: We enrolled 137 participants (62 in DA; 75 in VC). Mean age was 52.5. 19% were African-American, 78% white. 97% had at least some college education; 91% preferred active participation in decision-making. Mean CHD risk was 15%. 64% had a plan to lower their CHD risk. There were no baseline differences among groups. Following the interventions, we found no clinically or statistically significant differences between groups in decisional conflict (DA 1.84; VC 1.91; absolute difference VC-DA 0.07, 95% CI -0.15 to 0.28), intent to reduce CHD risk (DA 98%; VC 100%; absolute differences VC-DA: 2%, 95% CI -0.02% to 5%), self-efficacy for chosen risk reduction options (DA 97%; VC 92%; absolute difference VC-DA -5%, 95% CI -13% to 3%) or perceptions that decisions were consistent with personal values (DA 95%; VC 92%; absolute difference VC-DA: -3%, 95% CI -11% to 5%). In post-hoc analysis, more people in the VC group, however, changed their decision about how to lower their CHD risk.
Conclusions: Adding a ranking and rating VC intervention did not improve decision making compared with a decision aid alone in a trial of highly educated adults. It may, however, change participants’ choices for CHD risk reduction.