Abstract
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.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 866-874 |
| Number of pages | 9 |
| Journal | Medical Decision Making |
| Volume | 28 |
| Issue number | 6 |
| DOIs | |
| State | Published - Nov 1 2008 |
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Keywords
- Clinical competence
- Decision making
- Decision theory
- Evidence-based medicine
- Evidence-based practice
- Practice guidelines clinical psychology
ASJC Scopus subject areas
- Health Policy
Cite this
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Health decision making : Lynchpin of evidence-based practice. / Spring, Bonnie.
In: Medical Decision Making, Vol. 28, No. 6, 01.11.2008, p. 866-874.Research output: Contribution to journal › Review article
TY - JOUR
T1 - Health decision making
T2 - Lynchpin of evidence-based practice
AU - Spring, Bonnie
PY - 2008/11/1
Y1 - 2008/11/1
N2 - 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.
AB - 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.
KW - Clinical competence
KW - Decision making
KW - Decision theory
KW - Evidence-based medicine
KW - Evidence-based practice
KW - Practice guidelines clinical psychology
UR - http://www.scopus.com/inward/record.url?scp=57049137803&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=57049137803&partnerID=8YFLogxK
U2 - 10.1177/0272989X08326146
DO - 10.1177/0272989X08326146
M3 - Review article
VL - 28
SP - 866
EP - 874
JO - Medical Decision Making
JF - Medical Decision Making
SN - 0272-989X
IS - 6
ER -