Anjana
There is no easy answer to this complex question but 4 steps we
suggested in:
Glasziou PP, Irwig LM. An evidence based approach to individualising
treatment. BMJ. 1995 Nov 18;311(7016):1356-9.
were
1. Work out the average benefits and harms
2. Work out the individual's risk profile
3. Use that profile to predict the individual's expected benefits and harms
4. Weight those up with the patient
For a closely related but maybe simpler process see:
Straus SE. Individualizing treatment decisions. The likelihood of being
helped or harmed. Eval Health Prof. 2002 Jun;25(2):210-24.
Either process makes an assumption of constant relative risk reduction
(and varying absolute risk reduction). For some discussion of that see:
Glasziou PP, Sanders SL. Investigating causes of heterogeneity in
systematic reviews. Stat Med. 2002 Jun 15;21(11):1503-11.
Good luck,
Paul Glasziou
> Hello Tari and Ash,
>
> I agree that in terms of commissioning healthcare at the
> organisational or governmental level the policy of 'the good of the
> many outweighing the good of the few' is a sound one.
>
> However, what is often forgotten is that the 'abstract EBM patient' is
> derived from individual patient data (including patient values).
>
> At the clinical level, the difficulty is in deciding where the
> individual patient sitting in front of you is located in the
> distribution curve of the population from which the data about the
> effects of an intervention were derived. It is possible that a
> particular patient is located outside of this particular distribution
> curve.
>
> My question is:
>
> Once you have good evidence that a particular intervention is
> beneficial in most people most of the time, what steps need to be
> followed in the decision making process in order to ensure that the
> individual patient in front of you is the one who will benefit?.
>
> Anjana
>
>
>
> Dr Anjana Patel MRPharmS
> Independent Pharmaceutical Consultant
> Harrow, Middlesex
> UK
>
--
Paul Glasziou
Director, Centre for Evidence-Based Medicine,
Department of Primary Health Care,
University of Oxford www.cebm.net
ph +44-1865-227055 fax +44-1865-227036
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