Theory-informed design of values clarification methods: A cognitive psychological perspective on patient health-related decision making

A.H. Pieterse, M. de Vries, M. Kunneman, A.M. Stiggelbout, D. Feldman-Stewart

Research output: Contribution to journalArticleScientificpeer-review

53 Citations (Scopus)
88 Downloads (Pure)


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.
► Patient decision aids often include a method to help patients clarify how important they judge healthcare options or their attributes.
► Psychological theories on decision making identify the processes that assist value-consistent decision making.
► Based on theories we propose, for example, encouraging consideration of all appropriate options and facilitating the weighing of their attributes.
► Our recommendations advance transparent and coherent VCM design and evaluation.
Keywords: Decision making process, Preferences, Decision aid, Mental representation, Choice, Literature review
Original languageEnglish
Pages (from-to)156-163
JournalSocial Science & Medicine
Publication statusPublished - 2013


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