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Thank you to eveyone who has replied so far - the input and suggested reference sources have been very helpful. I hope they have been helpful to others too. The fourth of the 5 steps of EBM has been described as "Acting on the evidence, using patient values". Let's see if we can expand this discussion beyond publications. To everyone of this e-mail list, including those that have responded already, can anyone describe what tools, techniques, approaches they used to address this step in their clinical practice last month (November 2010)? Sharing our own real-time clinical practice experiences may be really helpful for others on this list. Sometimes the most innovative approaches may also appear the simplest - I am interested to hear from everyone. I will put my hand up and say - I am taking a year out of clinical practice and am working at the Institute for Healthcare Improvement - I saw no patients last month - but I am thinking deeply about how we make health care more patient centred and include patients values and preferences in decision making to achieve better health outcomes. I look forward to hearing what my colleagues on the evidence-based-health e-mail list have to contribute on this challenging issue. Cheers Malcolm Health Foundation/Institute for Healthcare Improvement Fellow Malcolm Daniel Department of Anaesthesia Walton Building Glasgow Royal Infirmary G4 0SF Tel: 44-(0)141-211-4620 Quoting Rakesh Biswas <[log in to unmask]>: > Thanks Piersante, > > For (1) there is this other recent book: > > http://www.igi-global.com/bookstore/TitleDetails.aspx?TitleId=41908&DetailsType=Preface > > COI: A few of our current members in this list have contributed chapters to > it. > > regards, > > rakesh > > On Fri, Nov 26, 2010 at 5:01 AM, Piersante Sestini <[log in to unmask]> wrote: > >> 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] >>> >>> >>> >>> >>> >>> ---------------------------------------------------------------- >>> This message was sent using IMP, the Internet Messaging Program. >>> >>> >>> >> > ---------------------------------------------------------------- This message was sent using IMP, the Internet Messaging Program.