Clarifying Values: An Updated and Expanded Systematic Review and Meta-Analysis

H.O. Witteman*, R. Ndjaboue, G. Vaisson, S.C. Dansokho, B. Arnold, J.F.P. Bridges, S. Comeau, A. Fagerlin, T. Gavaruzzi, M. Marcoux, A. Pieterse, M. Pignone, T. Provencher, C. Racine, D. Regier, C. Rochefort-Brihay, P. Thokala, M. Weernink, D.B. White, C.E. WillsJ. Jansen

*Corresponding author for this work

Research output: Contribution to journal(Systematic) Review article peer-review


Background Patient decision aids should help people make evidence-informed decisions aligned with their values. There is limited guidance about how to achieve such alignment. Purpose To describe the range of values clarification methods available to patient decision aid developers, synthesize evidence regarding their relative merits, and foster collection of evidence by offering researchers a proposed set of outcomes to report when evaluating the effects of values clarification methods. Data Sources MEDLINE, EMBASE, PubMed, Web of Science, the Cochrane Library, and CINAHL. Study Selection We included articles that described randomized trials of 1 or more explicit values clarification methods. From 30,648 records screened, we identified 33 articles describing trials of 43 values clarification methods. Data Extraction Two independent reviewers extracted details about each values clarification method and its evaluation. Data Synthesis Compared to control conditions or to implicit values clarification methods, explicit values clarification methods decreased the frequency of values-incongruent choices (risk difference, -0.04; 95% confidence interval [CI], -0.06 to -0.02; P < 0.001) and decisional conflict (standardized mean difference, -0.20; 95% CI, -0.29 to -0.11; P < 0.001). Multicriteria decision analysis led to more values-congruent decisions than other values clarification methods (chi(2) = 9.25, P = 0.01). There were no differences between different values clarification methods regarding decisional conflict (chi(2) = 6.08, P = 0.05). Limitations Some meta-analyses had high heterogeneity. We grouped values clarification methods into broad categories. Conclusions Current evidence suggests patient decision aids should include an explicit values clarification method. Developers may wish to specifically consider multicriteria decision analysis. Future evaluations of values clarification methods should report their effects on decisional conflict, decisions made, values congruence, and decisional regret.
Original languageEnglish
Pages (from-to)801-820
Number of pages20
JournalMedical Decision Making
Issue number7
Publication statusPublished - 1 Oct 2021


  • decision making
  • values clarification
  • shared decision making
  • preference elicitation
  • CARE
  • AIDS


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