# The Value Sensitivity Gap: How Clinical Large Language Models Respond to Patient Preference Statements in Shared Decision-Making

arXiv: https://arxiv.org/abs/2603.00076 · HTML: https://mlsanity.com/paper/2603.00076/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 3 of its 23 references that are in the map.
- First posted on arXiv 12 Feb 2026.

## Builds on (most cited first, 3 of 3)

- [Chain-of-Thought Prompting Elicits Reasoning in Large Language Models](https://mlsanity.com/paper/2201.11903/) (2022)
- [Bias patterns in the application of LLMs for clinical decision support: A comprehensive study](https://mlsanity.com/paper/2404.15149/) (2024)
- [CLIMB: A Benchmark of Clinical Bias in Large Language Models](https://mlsanity.com/paper/2407.05250/) (2024)

## Abstract (arXiv)

Large language models (LLMs) are entering clinical workflows as decision support tools, yet how they respond to explicit patient value statements -- the core content of shared decision-making -- remains unmeasured. We conducted a factorial experiment using clinical vignettes derived from 98,759 de-identified Medicaid encounter notes. We tested four LLM families (GPT-5.2, Claude 4.5 Sonnet, Gemini 3 Pro, and DeepSeek-R1) across 13 value conditions in two clinical domains, yielding 104 trials. Default value orientations differed across model families (aggressiveness range 2.0 to 3.5 on a 1-to-5 scale). Value sensitivity indices ranged from 0.13 to 0.27, and directional concordance with patient-stated preferences ranged from 0.625 to 1.0. All models acknowledged patient values in 100% of non-control trials, yet actual recommendation shifting remained modest. Decision-matrix and VIM self-report mitigations each improved directional concordance by 0.125 in a 78-trial Phase 2 evaluation. These findings provide empirical data for populating value disclosure labels proposed by clinical AI governance frameworks.