BMC Med Inform Decis Mak. 2013;13 Suppl 2(Suppl 2):S8. doi: 10.1186/1472-6947-13-S2-S8. Epub 2013 Nov 29.
Consensus guidelines have recommended that decision aids include a process for helping patients clarify their values. We sought to examine the theoretical and empirical evidence related to the use of values clarification methods in patient decision aids.
Building on the International Patient Decision Aid Standards (IPDAS) Collaboration's 2005 review of values clarification methods in decision aids, we convened a multi-disciplinary expert group to examine key definitions, decision-making process theories, and empirical evidence about the effects of values clarification methods in decision aids. To summarize the current state of theory and evidence about the role of values clarification methods in decision aids, we undertook a process of evidence review and summary.
Values clarification methods (VCMs) are best defined as methods to help patients think about the desirability of options or attributes of options within a specific decision context, in order to identify which option he/she prefers. Several decision making process theories were identified that can inform the design of values clarification methods, but no single "best" practice for how such methods should be constructed was determined. Our evidence review found that existing VCMs were used for a variety of different decisions, rarely referenced underlying theory for their design, but generally were well described in regard to their development process. Listing the pros and cons of a decision was the most common method used. The 13 trials that compared decision support with or without VCMs reached mixed results: some found that VCMs improved some decision-making processes, while others found no effect.
Values clarification methods may improve decision-making processes and potentially more distal outcomes. However, the small number of evaluations of VCMs and, where evaluations exist, the heterogeneity in outcome measures makes it difficult to determine their overall effectiveness or the specific characteristics that increase effectiveness.
共识指南建议决策辅助工具应包括帮助患者澄清价值观的流程。我们试图研究与在患者决策辅助工具中使用价值观澄清方法相关的理论和实证证据。
基于国际患者决策辅助工具标准（IPDAS）合作组织 2005 年对决策辅助工具中价值观澄清方法的审查，我们召集了一个多学科专家组，以检查关键定义、决策过程理论以及关于价值观澄清方法在决策辅助工具中的效果的实证证据。为了总结当前关于价值观澄清方法在决策辅助工具中的作用的理论和证据的状况，我们进行了证据审查和总结。
价值观澄清方法（VCMs）最好被定义为帮助患者思考特定决策情境下选项或选项属性的可取性的方法，以确定他/她更喜欢哪个选项。确定了几种可以为价值观澄清方法的设计提供信息的决策过程理论，但没有确定如何构建此类方法的单一“最佳”实践。我们的证据审查发现，现有的 VCMs 用于各种不同的决策，很少参考其设计的基础理论，但通常在其开发过程方面有很好的描述。列出决策的利弊是最常用的方法。比较有或没有 VCM 支持的决策支持的 13 项试验得出了混合结果：一些试验发现 VCMs 改善了一些决策过程，而其他试验则没有发现效果。
价值观澄清方法可能会改善决策过程并潜在地改善更遥远的结果。然而，评估 VCM 的数量较少，而且在有评估的情况下，衡量结果的指标也存在异质性，这使得难以确定它们的总体有效性或增加有效性的具体特征。
