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Better values clarification methods for better decisions

Date and Location




Saturday 21 September 2013 - 10:30 - 12:00


Presenting author and contact person

Presenting author

Holly Witteman

Contact person

Holly Witteman
Abstract text
Background: Shared decision making requires that decisions be grounded in patients' values and preferences. However, people frequently express preferences and make choices that are at odds with their stated values. This suggests that, for shared decision making to reach its full potential, better values clarification methods are needed. Objectives: To test whether interactive online values clarification exercises developed through user-centred design could help better align treatment preferences with stated values. Methods: We conducted a between-subjects online randomized experiment in a demographically diverse US-based population (n=2033, 46% male, 82% white, age range 18-68, 57% no college degree.) We first asked participants about their values relevant to colostomy versus death: if they had to choose, would they rather die or have a colostomy? Participants were then asked to imagine that they had been diagnosed with colon cancer. We presented evidence about two hypothetical treatment options differing only in that one had a 4% chance of colostomy while the other had an additional 4% chance of death. Participants in the control arm were immediately asked their treatment preference; participants in the other four arms first interacted with either a standard values clarification exercise, an interactive exercise, or one of two partially-interactive exercises. Exercises had been previously developed through user-centred design. Results: Consistent with our prior research, in the control arm, 22% of people expressed treatment preferences that were discordant with their previously stated values. After interacting with a standard values clarification exercise, discordance was not significantly changed at 23%. Partially-interactive exercises reduced discordance to 17-18%; the most interactive exercise lowered discordance to 14% (Chi-squared (4) = 13.90, p = .003). Conclusions: An interactive online values clarification exercise can help people better align treatment preferences with stated values. This method may help better incorporate patient values into health decisions.