This is a very important and neglected area of EBM.
To the pointers that have been given, I would add a few further points:
1) Narrative medicine/counselling as tools to investigate patient's values
2) This topic mostly overlaps with "Shared decision making"
2)There is a growing interest of this topic (mostly outside the EBM
community), under the term "context" and "contextual issues". For
example see:
Schwartz A, Weiner SJ, Harris IB, Binns-Calvey A. An educational intervention
for contextualizing patient care and medical students' abilities to probe for
contextual issues in simulated patients. JAMA. 2010 Sep 15;304(11):1191-7. PubMed
PMID: 20841532.
I can't help with your mathematical approach, since like most others that have tried it I found the utilitarian approach unpractical/unconvincing.
Nevertheless, you could have a look to the simplified "Korean car" (can't remember the make of the car she used, but she contrasted it with the "Rolls Royce" approach of full decision analysis) approach proposed by Sharon Straus some year ago.
If you insist in using the full utilitarian approach, then Jonathan Baron "Thinking and Deciding" could be your guide
regards
<http://www.cambridge.org/us/catalogue/catalogue.asp?isbn=9780521680431>Piersante Sestini
On 29/11/2010 5.14, Malcolm Daniel wrote:
> Dear all,
>
> This is a request for information on how to do that essential but often
> under-reported step in EBM: integrating the best available evidence with the
> patient's values and preferences.
>
> Situation: My colleagues and I are trying to figure out the best way to
> introduce evidence into our conversations with patients and to integrate their
> values with the best available evidence.
>
> Background: We are familiar with one suggested way of integrating the evidence
> with the patients values:
>
> Users’ Guides to the Medical Literature XX. Integrating Research Evidence With
> the Care of the Individual Patient
> http://jama.ama-assn.org/cgi/content/full/283/21/2829
>
> The concept of factoring in the likelihood of being helped and harmed is
> attractive – and while the arithmetic formula outlined in the above article
> looks relative simple:
>
> LHHA=[(1/NNT)*ft*s]: [(1/NNH)*fh]
>
> Where
>
> LHH = likelihood of being helped vs harmed
> NNT= number needed to treat to help/benefit
> NNH= number needed to treat to harm
> ft = risk of the treatment outcome event relative to that of the average control
> fh = risk of the harm outcome event relative to that of the average control
> s=severity factor,
>
> we wonder how many health professionals do easy it is to carry out this piece of
> arithmetic in the real-life of every day clinical practice..
>
> Assessment: We wonder if and how fellow healthcare professionals use this
> approach in practice? Has anyone developed a systematic approach to do this
> for the majority of patients they provide care for?
>
> Recommendations: I am interested in finding out the following information:
>
> 1. It would be interesting to hear of other practitioners experience in using
> such approach in their own practice.
> 2. If you have knowledge of other publications using a similar or easier
> approach I would be grateful for your knowledge and sources of information.
> 3. If anyone is has tips / tools / experience of using this approach in regular
> day-to-day clinical practice I would like to hear about them too.
> Many thanks for your help
>
> Malcolm
>
>
> Malcolm Daniel
>
> Consultant in Anaesthesia& Intensive Care, Glasgow Royal Infirmary
> E-mail: [log in to unmask]
>
>
>
> Health Foundation/IHI Fellow
> Institute for Healthcare Improvement
> 20 University Road, 7th Floor
> Cambridge, MA 02138
>
> Tel: (617) 301-4854
> Fax: (617) 301-4848
> E-mail: [log in to unmask]
>
>
>
>
>
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