But risk tolerance != patient values.
Part of patient values relate to risk tolerance; but there are many
other aspects of patient values that are not to do with tolerance of
risk, so we would be left with those...
Matt
[log in to unmask] wrote:
> Should we be paying more attention to the terminology we are using to
> describe the components of clinical decision making?
>
> For instance instead of trying to elicit patient values we could look
> for ways to develop objective tools to assess 'risk tolerence'. Such
> risk tolerance tool(s) could then be used to establish the risk
> tolerance level of both the patient and the physician in a particuler
> clincial decision making scenerio.
>
> The risk tolerance level of both the patient and the physician would
> need to be established as both influence the final decision that is made.
>
> With best wishes
>
> Anjana
>
>
>
> Anjana Patel BPharm MSc PhD MRPharmS
>
> Independent pharmaceutical scientist and writer
>
> UK
>
>
>
> >----Original Message----
> > From: [log in to unmask]
> > Date: Aug 13, 2007 1:57:18 PM
> > To: [log in to unmask]
> > Subj: Re: risk calculation and the clinical encounter
> >
> >
>
> One, of course, needs to distinguish between evidence and
> decision-making. But, even when we do, the fundamental problem that is
> frequently neglected in the discussion like this is that t/here is no
> such a thing as “gold standard” method for elicitation of patients’
> values. Or, in the other words, there is no such a thing as “gold
> standard” of rational decision-making/ (which is the reason why
> normative and descriptive theories of decision-making more often than
> not disagree with each other).
>
>
>
> I think explicit acknowledgements of this problem can help us move
> toward better definition of “rational decision-making”, which is what is
> desperately lacking.
>
>
>
> Benjamin Djulbegovic, MD,PhD
>> Professor of Oncology and Medicine
>> H. Lee Moffitt Cancer Center & Research Institute at the University of
> South Florida Department of Interdisciplinary Oncology, MRC, Floor 2,Rm#
> 2067H
>
> 12902 Magnolia Drive
>> Tampa, FL 33612
>
> e-mail:[log in to unmask]
>> e-mail:[log in to unmask]
>> http://www.hsc.usf.edu/~bdjulbeg/
>> phone:(813)745-4605
>> fax:(813)745-6132
>
>
>
> *From:* Evidence based health (EBH)
> [mailto:[log in to unmask]] *On Behalf Of *Rakesh Biswas
>> *Sent:* Monday, August 13, 2007 00:19
>> *To:* [log in to unmask]
>> *Subject:* Re: risk calculation and the clinical encounter
>
>
>
> Thanks John, I agree that risk estimation is important but then it may
> not be all that needs to be addressed in a clinical encounter.
> >
> > Dr Armstrong ( a dedicated EBMer in a US residency program) has
> identified a few queries that move beyond risk calculation in EBM and I
> am not sure if we have the answers:
> >
> > How do you gauge patient preference and values in the face of complex
> and multi-faceted decision making? How might you articulate the pros and
> cons of various treatment options in a clear, honest and meaningful way?
> >
> > How do you reach common ground with patients when the neatly packaged
> evidence is at odds with patient expectations while remaining respectful
> of the principle of patient autonomy?
> >
> > How do you teach learners and colleagues to deal with the uncertainty
> engendered by conflicting bodies of evidence or diametrically opposed
> interpretations thereof by various special interest groups?
> >
> > What conversations might you have with the patient when the evidence
> complicates the picture and hence the decision making process and the
> decision to test or treat is in many ways a "toss up"?
> >
> > How do you find reasonable answers to clinical questions that are of
> a complexity that is not conducive to the framing of a clear clinical
> question?
> >
> > What do you do if the best-available evidence runs counter to the
> so-called "standard of care" in your medical community? What if the
> "usual" treatment is of uncertain benefit but the potential harms of
> such a treatment are well known and can be quantified?
> >
> > What language might you use to facilitate the particular patient at
> hand making a decision that makes sense to them taking into account
> their broader context (cultural beliefs, educational background and
> literacy, numeracy and whether they are "risk adverse" or "risk tolerant")?
> >
> > What are the medico-legal and ethical ramifications of acting on good
> evidence that is not considered "usual" care?
> >
> > Would be interested to know the answers but my guess is that this may
> constitute a question flooding that is in variance with the focussed
> query approach. However we could take them one at a time and perhaps
> each one of us could work to answer some (not all of these).
> >
> > rakesh
> >
> >
>
> On 8/9/07, *J C Platt* <[log in to unmask]
> <mailto:[log in to unmask]>> wrote:
>
>
> > Dear Doctor Biswas
> > A very interesting paper.
> > I think at present I would rather risk treatment based on strong
> evidence, even
> > though it may not apply to me as an individual; at least I have some
> idea of
> > the level of risk incurred.
> > My best guess is that leaving it to the doctor to personalise the
> treatment
> > means I have no way of estimating the risk ( what is the doctors
> knowledge
> > base,how up to date are they etc.) My reading of the history in this
> area
> > would suggest risk may be high. Perhaps this risk comparison is an
> area for
> > further study.
> > Yours sincerely John Platt
> >
> > Quoting Rakesh Biswas <[log in to unmask]
> <mailto:[log in to unmask]>>:
> >
> > > Wanted to share this article from our institute written in
> collaboration
> > > with colleagues from
> > > other institutes.
> > > Click on:
> > >
> http://www.blackwell-synergy.com/doi/abs/10.1111/j.1365-2753.2007.00837.x
> > >
> > > It begins as an autoethnographic reflection of an individual physician
> > > exploring the relationship between his largely qualitative day to day
> > > clinical activity
> > > with individual patients and population based average patient data
> > > (that is largely quantitative).
> > >
> > > Following this write up we have been inspired to work towards
> trying to
> > > leverage ICT
> > > for answering individual health information needs and are grateful
> to be
> > > able to keep
> > > learning from colleagues across multiple disciplines from the pure
> clinical
> > > to pure informatics.
> > >
> > > Another issue is much as one would love to publish open access we were
> > > compelled to publish with a closed access publisher as it is
> difficult to
> > > obtain organizational funding for
> > > the fee open access journals need (although they do give generous
> waivers on
> > > an individual basis).
> > > Interestingly even closed access journals seem to be catching on to
> the idea
> > > by offering
> > > individual authors the option to pay to unlock their own articles
> and make
> > > them open.However
> > > I have the provision to freely share the pdf full text if you are
> interested
> > > in reading the
> > > article.
> > >
> > > rakesh
> > >
> >
> >
>
>
>
>
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