Purpose: Making health care treatment decisions in accordance with patients' values is a fundamental component of high quality care, particularly in the domain of preference-sensitive care. “Values clarification exercises” are often incorporated into programs of decision support (e.g., decision aids) as a basis for patients to identify and express the attributes and options salient to their decision making process. While the Decisional Conflict Scale is often used to evaluate these exercises from a psychometric perspective, there are no established measures upon which to evaluate them from an operational perspective. The purpose of this study is to develop a framework to guide the formal evaluation of the processes involved in values clarification exercises.
Methods: We searched the literature for published work on the evaluation of values clarification exercises. We paid particular attention to work conducted in the field of preference elicitation and decision modeling, given that many values clarification exercises extend from this work. We were specifically interested in those studies that evaluated exercises in terms of their required actions or steps and the level of acceptability from the user's perspective. Abstracts were reviewed for relevance. Full articles were reviewed for outcomes of interest.
Results: Our search resulted in the identification of five primary domains: 1) comprehensibility – the level of difficulty required to perform the exercise; 2) numerical orientation – translation of information artifacts (quantitatively or qualitatively); 3) time – the length of time required to perform the exercise; 4) interaction – the acceptability of the level of tradeoff engagement; and, 5) response format – the representativeness of the response format. These domains served as the basis for our framework development. Questions relating to these domains are being designed as part of a formal instrument development.
Conclusion: A variety of values clarification exercises have been developed and incorporated into decision support programs. Comparing these exercises – separate from the decision support process – is an important aspect to better understanding their role in high quality patient decision making. Moreover, assessing the process of values clarification will lend greater insight into decisional conflict. The framework proposed in this study is an early step in rigorously measuring these processes and the systematic evaluation of values clarification exercises.
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