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What Helps People Make Values-Congruent Medical Decisions? Eleven Strategies Tested across 6 Studies

Author

Listed:
  • Holly O. Witteman

    (Universite Laval Faculte de medecine, Quebec, QC, Canada)

  • Anne-Sophie Julien

    (Universite Laval Faculte des sciences et de genie, Quebec, QC, Canada)

  • Ruth Ndjaboue

    (Universite Laval Faculte de medecine, Quebec, QC, Canada)

  • Nicole L. Exe

    (University of Michigan Medical School, Ann Arbor, MI, USA)

  • Valerie C. Kahn

    (University of Michigan Medical School, Ann Arbor, MI, USA)

  • Angela (Angie) Fagerlin

    (University of Utah School of Medicine, Salt Lake City, UT, USA)

  • Brian J. Zikmund-Fisher

    (University of Michigan School of Public Health, Ann Arbor, MI, USA)

Abstract

Background. High-quality health decisions are often defined as those that are both evidence informed and values congruent. A values-congruent decision aligns with what matters to those most affected by the decision. Values clarification methods are intended to support values-congruent decisions, but their effects on values congruence are rarely evaluated. Methods. We tested 11 strategies, including the 3 most commonly used values clarification methods, across 6 between-subjects online randomized experiments in demographically diverse US populations ( n 1 = 1346, n 2 = 456, n 3 = 840, n 4 = 1178, n 5 = 841, n 6 = 2033) in the same hypothetical decision. Our primary outcome was values congruence. Decisional conflict was a secondary outcome in studies 3 to 6. Results. Two commonly used values clarification methods (pros and cons, rating scales) reduced decisional conflict but did not encourage values-congruent decisions. Strategies using mathematical models to show participants which option aligned with what mattered to them encouraged values-congruent decisions and reduced decisional conflict when assessed. Limitations. A hypothetical decision was necessary for ethical reasons, as we believed some strategies may harm decision quality. Later studies used more outcomes and covariates. Results may not generalize outside US-based adults with online access. We assumed validity and stability of values during the brief experiments. Conclusions. Failing to explicitly support the process of aligning options with values leads to increased proportions of values-incongruent decisions. Methods representing more than half of values clarification methods commonly in use failed to encourage values-congruent decisions. Methods that use models to explicitly show people how options align with their values offer more promise for helping people make decisions aligned with what matters to them. Decisional conflict, while arguably an important outcome in and of itself, is not an appropriate proxy for values congruence.

Suggested Citation

  • Holly O. Witteman & Anne-Sophie Julien & Ruth Ndjaboue & Nicole L. Exe & Valerie C. Kahn & Angela (Angie) Fagerlin & Brian J. Zikmund-Fisher, 2020. "What Helps People Make Values-Congruent Medical Decisions? Eleven Strategies Tested across 6 Studies," Medical Decision Making, , vol. 40(3), pages 266-278, April.
    • Handle: RePEc:sae:medema:v:40:y:2020:i:3:p:266-278
    DOI: 10.1177/0272989X20904955
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    References listed on IDEAS

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    1. Holly O. Witteman & Selma Chipenda Dansokho & Nicole Exe & Audrey Dupuis & Thierry Provencher & Brian J. Zikmund‐Fisher, 2015. "Risk Communication, Values Clarification, and Vaccination Decisions," Risk Analysis, John Wiley & Sons, vol. 35(10), pages 1801-1819, October.
    2. repec:cup:judgdm:v:1:y:2006:i::p:64-75 is not listed on IDEAS
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    1. Holly O. Witteman & Ruth Ndjaboue & Gratianne Vaisson & Selma Chipenda Dansokho & Bob Arnold & John F. P. Bridges & Sandrine Comeau & Angela Fagerlin & Teresa Gavaruzzi & Melina Marcoux & Arwen Pieter, 2021. "Clarifying Values: An Updated and Expanded Systematic Review and Meta-Analysis," Medical Decision Making, , vol. 41(7), pages 801-820, October.
    2. Alison E. Butler & Gretchen B. Chapman, 2022. "Don’t Throw Your Heart Away: Increased Transparency of Donor Utilization Practices in Transplant Center Report Cards Alters How Center Performance Is Evaluated," Medical Decision Making, , vol. 42(3), pages 341-351, April.

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