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Dear Malcolm That's an excellent - and difficult - question. Different circumstances will require different methods. A cardiac arrest, tennis elbow, and a decision about major surgery have different dimensions of patient involvement and options. In general practice, I most often use the method suggested in the Irwig's book Smart Health Choices: 1. What would happen if I do nothing? (Natural history or prognosis) * 2. What are the treatment options? 3. What are the Benefits and harms? (What? When? How probable?) 4. How do the options change the prognosis? Though I'll modify this with the type and severity of the condition. but for some things (major surgery or warfarinization) a decision aid might be warranted. With either method, there can be the problem of adjusting the risks & benefits to the individuals profile (as the User Guide suggests). Sometimes we'll have a good clinical prediction rule to give the absolute value, and sometimes we'll need to estimate that by using a relative method (the ft and fh mentioned in the User Guide). Cheers Paul Glasziou * Oncology friends tell me though don't like starting with this Q, but for general practice - with lots of self-limiting conditions - its the best place to start. >>> Malcolm Daniel 29/11/10 14:25 >>> 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] ---------------------------------------------------------------- This message was sent using IMP, the Internet Messaging Program.