Patient values in healthcare decision-making: Systematic umbrella review and framework for value-informed interventions (Preprint)

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Abstract
BACKGROUND Patient values play a central role in shaping health-related decisions, yet existing evidence on the breadth, structure, and operationalization of these values remains fragmented. Prior reviews have typically focused on specific conditions, populations, or isolated value constructs, limiting understanding of how patient values are conceptualized and applied across diverse health care decision-making contexts. In addition, there is a lack of integrative, cross-context frameworks that systematically organize patient values to inform research and practice. OBJECTIVE This umbrella review aims to systematically synthesize how patient values have been defined, operationalized, and reported across existing review literature, and to develop a foundational, integrative, and theoretically informed framework of patient values relevant to health decision-making across healthcare settings. METHODS The umbrella review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Three databases (EMBASE, PubMed, and Web of Science) were searched for reviews that examined patient values in relation to health decisions. The Joanna Briggs Institute’s (JBI) critical appraisal tool was applied to assess the quality of included reviews. A mixed synthesis approach combined deductive mapping to established value theories with inductive thematic analysis of extracted value constructs, followed by a best-fit framework synthesis to integrate and interpret the findings. RESULTS A total of 41 reviews were included, spanning diverse patient groups and healthcare contexts. We synthesized 27 value-related themes into 11 higher-order patient values, forming a comprehensive cross-context framework of patient values in healthcare decisions. Key values, such as informed empowerment, treatment feasibility, trust, relational obligations, and cultural or traditional beliefs, were consistently present across conditions and settings. Importantly, this review also identified patient value domains that are largely absent from prior syntheses, including interpersonal dignity and sense of certainty, revealing critical blind spots in how patient values have been conceptualized to date. The resulting framework provides both conceptual clarity and practical relevance for researchers, clinicians, policy makers, and decision-support interventions. CONCLUSIONS This umbrella review is the first to systematically synthesize patient values across diverse healthcare contexts. The resulting initial framework expands prior conceptualizations of patient values and identifies domains not previously captured in condition-specific or fragmented syntheses. These findings offer a robust foundation for operationalizing patient values in decision-making research, value-sensitive design, shared decision-making, patient-centered care initiatives, and digital health and AI-enabled clinical decision support systems. Future work should validate this framework across cultural groups and decision contexts and explore how specific value profiles influence engagement with health information and choices. CLINICALTRIAL PROSPERO (CRD420261279805)

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