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Short Graphic Values History Tool for decision making during serious illness
  1. John J You1,
  2. Peter Allatt2,
  3. Michelle Howard3,
  4. Carole A Robinson4,
  5. Jessica Simon5,
  6. Rebecca Sudore6,
  7. Amy Tan7,
  8. Carrie Bernard8,9,
  9. Marilyn Swinton10,
  10. Xuran Jiang11,
  11. Doug Klein12,
  12. Michael McKenzie13,
  13. Gillian Fyles14 and
  14. Daren Keith Heyland15
  1. 1 Medicine, McMaster University, Hamilton, Canada
  2. 2 Bridgepoint Active Healthcare, Toronto, Ontario, Canada
  3. 3 Family Medicine, McMaster University, Hamilton, Ontario, Canada
  4. 4 School of Nursing, University of British Columbia Okanagan, Kelowna, British Columbia, Canada
  5. 5 Oncology and Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
  6. 6 Division of Geriatrics, University of California, San Francisco, California, USA
  7. 7 Department of Family Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
  8. 8 Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
  9. 9 Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
  10. 10 Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
  11. 11 Clinical Evaluation Research Unit (CERU), Kingston General Hospital, Kingston, Ontario, Canada
  12. 12 Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
  13. 13 BC Cancer Agency, Vancouver, British Columbia, Canada
  14. 14 BC Centre for Palliative Care, Vancouver, British Columbia, Canada
  15. 15 Department of Critical Care Medicine, Queen's University, Kingston, Ontario, Canada
  1. Correspondence to Dr John J You, Department of Medicine, McMaster University, Hamilton, ON L8S 4K1, Canada; jyou{at}


Objectives To develop and validate a values clarification tool, the Short Graphic Values History Tool (GVHT), designed to support person-centred decision making during serious illness.

Methods The development phase included input from experts and laypersons and assessed acceptability with patients/family members. In the validation phase, we recruited additional participants into a before–after study. Our primary validation hypothesis was that the tool would reduce scores on the Decisional Conflict Scale (DCS) at 1–2 weeks of follow-up. Our secondary validation hypotheses were that the tool would improve values clarity (reduce scores) more than other DCS subscales and increase engagement in advance care planning (ACP) processes related to identification and discussion of one’s values.

Results In the development phase, the tool received positive overall ratings from 22 patients/family members in hospital (mean score 4.3; 1=very poor; 5=very good) and family practice (mean score 4.5) settings. In the validation phase, we enrolled 157 patients (mean age 71.8 years) from family practice, cancer clinic and hospital settings. After tool completion, decisional conflict decreased (−6.7 points, 95% CI −11.1 to −2.3, p=0.003; 0–100 scale; N=100), with the most improvement seen in the values clarity subscale (−10.0 points, 95% CI −17.3 to −2.7, p=0.008; N=100), and the ACP-Values process score increased (+0.4 points, 95% CI 0.2 to 0.6, p=0.001; 1–5 scale; N=61).

Conclusions The Short GVHT is acceptable to end users and has some measure of validity. Further study to evaluate its impact on decision making during serious illness is warranted.

  • values
  • communication
  • clinical decisions
  • questionnaire
  • validation

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  • Contributors All authors contributed to the design of the work, or the acquisition, analysis or interpretation of data. JJY drafted the manuscript and all authors revised it critically for important intellectual content. All authors gave final approval of the version of the manuscript submitted for publication. JJY agrees to be accountable for all aspects of the work and ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding This work was supported by research grants from the Ontario Ministry of Health and Long-Term Care, the Canadian Frailty Network (core research grants 2013-30, 2013-13A), the Canadian Institutes of Health Research (PHE-135930) and the British Columbia Cancer Foundation.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.