Dear all,
Since I'd been discussing decision analysis with a colleague, I was
very interested to see a systematic review of decision aids in this
weeks BMJ (BMJ 1999;319:731-734).
The article shows that decision aids increase knowledge (a big effect
but complex interventions didn't appear much better than simple ones)
and reduced decisional conflict (I've no proper idea what a reduction
in decisional conflict score of 0.3 out of 5 means, but from the way
they describe it I'm not sure the effect is very big - any
comments?). Only one of the studies cited appeared to use decision
analysis and this involved doctors deciding on hep B vaccination.
My reading of it is that simple measures to structure how you give
patients information are helpful in at least some respects. There
doesn't appear to be much evidence one way or the other on more
complex aids like decision analysis.
In EBM decision analysis is often written about as if it is the 'gold
standard' of decision making (eg being the "black belt"
interpretation of diagnostic tests in Clinical Epidemiology).
We were wondering why it has achieved this status? I can see that it
is intellectually attractive (logical, clear, explicit) but is there
an evidence basis for it being what we should aspire to (since
I currently feel a bit guilty about never attempting it)?
Bruce
Bruce Guthrie,
MRC Training Fellow in Health Services Research,
Department of General Practice,
University of Edinburgh,
20 West Richmond Street,
Edinburgh EH8 9DX
Tel 0131 650 9237
e-mail [log in to unmask]
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