Involving Patients in Their Care Decisions and JAMA Editorial: The New Cholesterol and Blood Pressure Guidelines: Perspective on the Path Forward
Krumholz HM. The New Cholesterol and Blood Pressure Guidelines: Perspective on the Path Forward. JAMA. 2014 Mar 29. doi: 10.1001/jama.2014.2634. [Epub ahead of print] PubMed PMID: 24682222.
Here is an excellent editorial that highlights the importance of patient decision-making. We thank the wonderful Dr. Richard Lehman, MA, BM, BCh, Oxford, & Blogger, BMJ Journal Watch, for bringing this to our attention. [Note: Richard's wonderful weekly review of medical journals—informative, inspiring and oh so droll—is here.]
We have often observed that evidence can be a neutralizing force. This editorial highlights for us that this means involving the patient in a meaningful way and finding ways to support decisions based on patients’ personal requirements. These personal “patient requirements” include health care needs and wants and a recognition of individual circumstances, values and preferences.
To achieve this, we believe that patients should receive the same information as clinicians including what alternatives are available, a quantified assessment of potential benefits and harms of each including the strength of evidence for each and potential consequences of making various choices including things like vitality and cost.
Decisions may differ between patients, and physicians may make incorrect assumption about what most matters to patients of which there are many examples in the literature such as in the citations below.
O’Connor A. Using patient decision aids to promote evidence-based decision making. ACP J Club. 2001 Jul-Aug;135(1):A11-2. PubMed PMID: 11471526.
O’Connor AM, Wennberg JE, Legare F, Llewellyn-Thomas HA,Moulton BW, Sepucha KR, et al. Toward the ‘tipping point’: decision aids and informed patient choice. Health Affairs 2007;26(3):716-25.
Rothwell PM. External validity of randomised controlled trials: “to whom do the results of this trial apply?”. Lancet. 2005 Jan 1-7;365(9453):82-93. PubMed PMID: 15639683.
Stacey D, Bennett CL, Barry MJ, Col NF, Eden KB, Holmes-Rovner M, Llewellyn-Thomas H, Lyddiatt A, Légaré F, Thomson R. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev. 2011 Oct 5;(10):CD001431. Review. PubMed PMID: 21975733.
Wennberg JE, O’Connor AM, Collins ED, Weinstein JN. Extending the P4P agenda, part 1: how Medicare can improve patient decision making and reduce unnecessary care. Health Aff (Millwood). 2007 Nov-Dec;26(6):1564-74. PubMed PMID: 17978377.