Malcolm
You might find these papers relevant to your questions:
Values-based practice in primary care: easing the tensions between individual values, ethical principles and best evidence.
Mila Petrova, Jeremy Dale, Bill (KWM) Fulford.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1876638/
(if this and the following curriculum statement are relevant, look for more articles by Bill Fulford)
Ethics and Values Based Medicine
curriculum statement, RCGP
http://www.rcgp.org.uk/PDF/educ_ethicsAndVBPsfRCGPCouncilDec2005.pdf
Beyond Information: Exploring Patients' Preferences
Ronald M. Epstein, MD; Ellen Peters, PhD
http://jama.ama-assn.org/cgi/content/extract/302/2/195
You might also want to explore the literature on shared decision-making, although this is mostly about the (computerized) tools to help you do this
Best wishes
Michael
-----Original Message-----
From: Malcolm Daniel [mailto:[log in to unmask]]
Sent: 29 November 2010 04:15
Subject: Integrating patients values into clinical decision making
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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