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Apply the evidence to the patient.

Appropriate decision making integrates the context, values and preferences of the patient, as well as available resources, including professional expertise.


Patient Values

Patients vary in how much they want to know about their condition, how much they are ready to commit to change, and what is important to their lifestyle to list just a few factors. Smith's book (below) discusses how to address such value-based issues during the patient-physician consultation. Decision aids should also take them into account when assisting decisions on selecting care.
Smith's Patient Centered Interviewing Smith's Patient Centered Interviewing: an Evidence-Based Method
by Auguste H. Fortin Publication Date: 2012
Smith's Patient Centered Interviewing Users' Guides to the Medical Literature -- Chapter 27: Decision Making and the Patient
by Gordon Guyatt Publication Date: 2014

Decision Aids

"Decision aids appeared to have a positive effect on patient-practitioner communication." From: Stacey, D et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database of Systematic Reviews, 2014 Jan 28; CD001431.

  • Absolute CVD Risk/Benefit Calculator
    Provides an absolute estimate (%) of a person's chance of having a cardiovascular event over a specific period of time and an idea of the potential benefit of treatment. It includes the Framingham calculator.
  • Mayo Clinic Shared Decision Making National Resource Center
    Advances patient-centered medical care by promoting shared-decision making through the development, implementation, and assessment of patient decision aids and shared decision making techniques.
  • Ottawa Patient Decision Aids
    Includes the Ottawa Personal Decision Guides, which can help people identify their decision-making needs, plan the next steps, track their progress, and share their views about the decision.
  • USPSTF ePSS Tool
    Electronic Preventive Services Selector: search and browse U.S. Preventive Services Task Force (USPSTF) recommendations and guidelines. Mobile friendly.

Applying the Evidence Worksheet

Similar Patients

1. Are your patients similar to those in the study?

2. Are they so different that the results can’t help you?

3. How much of the study effect can you expect for your patients?

Realistic Interventions

4. Is the intervention realistic in your setting?

5. Does the comparison intervention reflect your current practice?

6. What alternatives are available?

Right Outcomes

7. Have all the right outcomes been considered?

8. Are the outcomes appropriate to your patient?

9. Does the intervention meet their values and preferences?

Adapted from: Heneghan, Carl and Badenoch, Douglas. Evidence-Based Medicine Toolkit, 2nd edition. Oxford: Blackwell Publishing: BMJ Books. 2006, p. 71.

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