Effect of Adding a Values Clarification Exercise to a Decision Aid on Heart Disease Prevention: A Randomized Trial

Stacey L. Sheridan, Jennifer M. Griffith, Lindy Behrend, Ziya Gizlice, Jianwen Cai and Michael P. Pignone
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Stacey L. Sheridan: Division of General Medicine and Clinical Epidemiology, University of North Carolina, Chapel Hill, sls593@med.unc.edu
Jennifer M. Griffith: Division of General Medicine and Clinical Epidemiology, University of North Carolina, Chapel Hill, Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill, Sheps Center for Health Services Research, University of North Carolina, Chapel Hill
Lindy Behrend: Division of General Medicine and Clinical Epidemiology, University of North Carolina, Chapel Hill, Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill, Sheps Center for Health Services Research, University of North Carolina, Chapel Hill
Ziya Gizlice: Division of General Medicine and Clinical Epidemiology, University of North Carolina, Chapel Hill, Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill, Sheps Center for Health Services Research, University of North Carolina, Chapel Hill
Jianwen Cai: Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, Department of Biostatistics, University of North Carolina, Chapel Hill
Michael P. Pignone: Division of General Medicine and Clinical Epidemiology, University of North Carolina, Chapel Hill, Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill, Sheps Center for Health Services Research, University of North Carolina, Chapel Hill

Medical Decision Making, 2010, vol. 30, issue 4, E28-E39

Abstract: Background. Experts have called for the inclusion of values clarification (VC) exercises in decision aids (DAs) as a means of improving their effectiveness, but little research has examined the effects of such exercises. Objective. To determine whether adding a VC exercise to a DA on heart disease prevention improves decision-making outcomes. Design. Randomized trial. Setting. UNC Decision Support Laboratory. Patients. Adults ages 40 to 80 with no history of cardiovascular disease. Intervention. A Web-based heart disease prevention DA with or without a VC exercise. Measurements. Pre- and postintervention decisional conflict and intent to reduce coronary heart disease (CHD) risk and postintervention self-efficacy and perceived values concordance. Results. The authors enrolled 137 participants (62 in DA; 75 in DA + VC with moderate decisional conflict (DA 2.4; DA + VC 2.5) and no baseline differences among groups. After the interventions, they found no clinically or statistically significant differences between groups in decisional conflict (DA 1.8; DA + VC 1.9; absolute difference VC—DA 0.1, 95% confidence interval [CI]: —0.1 to 0.3), intent to reduce CHD risk (DA 98%; DA + VC 100%; absolute difference VC—DA: 2%, 95% CI: —0.02% to 5%), perceived values concordance (DA 95%; DA + VC 92%; absolute difference VC—DA —3%, 95% CI: —11% to +5%), or self-efficacy for risk reduction (DA 97%; DA + VC 92%; absolute difference VC—DA —5%, 95% CI: —13% to +3%). However, DA + VC tended to change some decisions about risk reduction strategies. Limitations. Use of a hypothetical scenario; ceiling effects for some outcomes. Conclusions. Adding a VC intervention to a DA did not further improve decision-making outcomes in a population of highly educated and motivated adults responding to scenario-based questions. Work is needed to determine the effects of VC on more diverse populations and more distal outcomes.

Keywords: risk stratification; decision aids; patient decision making; provider decision making; risk communication or risk perception; shared decision making. (search for similar items in EconPapers)
Date: 2010
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Persistent link: https://EconPapers.repec.org/RePEc:sae:medema:v:30:y:2010:i:4:p:e28-e39

DOI: 10.1177/0272989X10369008

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