Department of Medical Decision Making, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, the Netherlands.
Soc Sci Med. 2013 Jan;77:156-63. doi: 10.1016/j.socscimed.2012.11.020. Epub 2012 Nov 27.
Healthcare decisions, particularly those involving weighing benefits and harms that may significantly affect quality and/or length of life, should reflect patients' preferences. To support patients in making choices, patient decision aids and values clarification methods (VCM) in particular have been developed. VCM intend to help patients to determine the aspects of the choices that are important to their selection of a preferred option. Several types of VCM exist. However, they are often designed without clear reference to theory, which makes it difficult for their development to be systematic and internally coherent. Our goal was to provide theory-informed recommendations for the design of VCM. Process theories of decision making specify components of decision processes, thus, identify particular processes that VCM could aim to facilitate. We conducted a review of the MEDLINE and PsycINFO databases and of references to theories included in retrieved papers, to identify process theories of decision making. We selected a theory if (a) it fulfilled criteria for a process theory; (b) provided a coherent description of the whole process of decision making; and (c) empirical evidence supports at least some of its postulates. Four theories met our criteria: Image Theory, Differentiation and Consolidation theory, Parallel Constraint Satisfaction theory, and Fuzzy-trace Theory. Based on these, we propose that VCM should: help optimize mental representations; encourage considering all potentially appropriate options; delay selection of an initially favoured option; facilitate the retrieval of relevant values from memory; facilitate the comparison of options and their attributes; and offer time to decide. In conclusion, our theory-based design recommendations are explicit and transparent, providing an opportunity to test each in a systematic manner.
医疗保健决策，特别是那些涉及权衡可能对生活质量和/或寿命产生重大影响的益处和危害的决策，应该反映患者的偏好。为了帮助患者做出选择，专门开发了患者决策辅助工具和价值观澄清方法（VCM）。VCM 旨在帮助患者确定选择中对其选择首选方案重要的方面。存在几种类型的 VCM。然而，它们通常是在没有明确参考理论的情况下设计的，这使得它们的开发难以系统化和具有内在一致性。我们的目标是为 VCM 的设计提供基于理论的建议。决策的过程理论指定了决策过程的组成部分，因此，可以确定 VCM 可以旨在促进的特定过程。我们对 MEDLINE 和 PsycINFO 数据库进行了回顾，并对检索到的论文中包含的理论的参考文献进行了回顾，以确定决策的过程理论。如果（a）它符合过程理论的标准；（b）提供了决策全过程的连贯描述；并且（c）经验证据支持其至少部分假设，我们就会选择一个理论。有四个理论符合我们的标准：图像理论、区分和整合理论、并行约束满足理论和模糊痕迹理论。基于这些，我们建议 VCM 应该：帮助优化心理表征；鼓励考虑所有潜在的适当选项；延迟选择最初青睐的选项；促进从记忆中检索相关价值观；促进选项及其属性的比较；并提供时间做出决定。总之，我们基于理论的设计建议是明确和透明的，为系统地测试每个建议提供了机会。
