A GUIDING FRAMEWORK FOR THE EVALUATION OF VALUES CLARIFICATION EXERCISES

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.�