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Health Decision Making: Lynchpin of Evidence-Based Practice

Feinberg School of Medicine, Northwestern University,Chicago, Illinois, and Hines Hospital VA Medical Center, Chicago, Illinois,bspring{at}northwestern.edu

Health decision making is both the lynchpin and the least developed aspect of evidence-based practice. The evidence-based practice process requires integrating the evidence with consideration of practical resources and patient preferences and doing so via a process that is genuinely collaborative. Yet, the literature is largely silent about how to accomplish integrative, shared decision making. Implications for evidence-based practice are discussed for 2 theories of clinician decision making (expected utility and fuzzy trace) and 2 theories of patient health decision making (transtheoretical model and reasoned action). Three suggestions are offered. First, it would be advantageous to have theory-based algorithms that weight and integrate the 3 data strands (evidence, resources, preferences) in different decisional contexts. Second, patients, not providers, make the decisions of greatest impact on public health, and those decisions are behavioral. Consequently, theory explicating how provider-patient collaboration can influence patient lifestyle decisions made miles from the provider's office is greatly needed. Third, although the preponderance of data on complex decisions supports a computational approach, such an approach to evidence-based practice is too impractical to be widely applied at present. More troublesomely, until patients come to trust decisions made computationally more than they trust their providers' intuitions, patient adherence will remain problematic. A good theory of integrative, collaborative health decision making remains needed.

Key Words: decision making • decision theory • evidence-based practice • evidence-based medicine • clinical competence • practice guidelines clinical psychology.

This version was published on November 1, 2008

Medical Decision Making, Vol. 28, No. 6, 866-874 (2008)
DOI: 10.1177/0272989X08326146


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