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Rethinking the Objectives of Decision Aids: A Call for Conceptual Clarity

Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, nelsonw{at}mail.nih.gov

Paul K. J. Han, MD

Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, Maryland

Angela Fagerlin, PhD

VA Health Services Research & Development Center for Practice Management and Outcomes Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan

Michael Stefanek, PhD

Behavioral Research Center, American Cancer Society, Atlanta, Georgia

Peter A. Ubel, MD

VA Health Services Research & Development Center for Practice Management and Outcomes Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan

Health decision aids are a potentially valuable adjunct to patient-physician communication and decision making. Although the overarching goal of decision aids— to help patients make informed, preference-sensitive choices—is widely accepted, experts do not agree on the means to achieve this end. In this article, the authors critically examine the theoretical basis and appropriateness of 2 widely accepted criteria used to evaluate decision aids: values clarification and reduction of decisional conflict. First, they argue that although clarifying values is central to decision making under uncertainty, it is not clear that decision aids—as they have been conceived and operationalized so far—can and should be used to achieve this goal. The pursuit of clarifying values, particularly values clarification exercises, raises a number of ethical, methodological, and conceptual issues, and the authors suggest research questions that should be addressed before values clarification is routinely endorsed. Second, the authors argue that the goal of reducing decisional conflict is conceptually untenable and propose that it be eliminated as an objective of decision aids.

Key Words: Key words: decision aids • decision making • decisional conflict • values clarification. (Med Decis Making 2007;27:609—618)

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