Evidence Based Medicine and Shared Decision Making: The challenge of getting both evidence and preferences into health care |
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| Institution: | 1. Allergy, Asthma, and Sinus Center, Greenfield, Wisconsin;2. The Problem Based Learning Institute, Chesterfield, Missouri;3. AltusLearn, Madison, Wisconsin;4. SDM Analytics, Inc, Houston, Texas;1. Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands;2. Department of Family Medicine, CAPHRI, Maastricht University Medical Centre, PO Box 616, 6200 MD, Maastricht, The Netherlands;3. Department of Surgery, Amsterdam University Medical Centers, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands;4. Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Centre, Post zone J10-S, Postbus 9600, 2300 RC, Leiden, The Netherlands;5. Department of Innovation, CZ Healthcare Insurance, Postbus 90152, 5000 LD, Tilburg, The Netherlands;6. Board of directors, Reinier de Graaf Hospital, Reinier de Graafweg 5, 2625 AD, Delft, The Netherlands;1. Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, USA;2. Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, USA;3. Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, USA;4. Division of Pulmonary and Critical Care, Department of Medicine, Mayo Clinic, Rochester, USA;5. Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USA;6. Division of Community Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, USA;7. Program in Bioethics, Mayo Clinic, Rochester, USA;8. Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Netherlands;1. The Gehr Family Center for Health Systems Science, Keck School of Medicine, University of Southern California, Los Angeles, USA;2. University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Health Behavior, 135 Dauer Drive, 302 Rosenau Hall, CB #7440, Chapel Hill, NC 27599-7440, USA;3. American Institutes for Research, Research and Evaluation, 100 Europa Drive, Suite 315, Chapel Hill, NC 27517, USA;4. Division of Pharmaceutical Outcomes and Policy UNC Eshelman School of Pharmacy, UNC Health Sciences at MAHEC, University of North Carolina at Chapel Hill, 121 Hendersonville Road, Asheville, NC, 28803, USA;1. Faculty of Health Sciences, Department of Health and Caring Sciences, UiT The Arctic University of Norway, Postbox 6050, Langnes, Norway;2. E-Health, Integrative care and Innovation Center, University Hospital of North Norway HF, Postbox 100, 9038 Tromsø, Norway;3. The South-Eastern Norway Regional Health Authority, Department of Medicine and Healthcare, Postbox 404, N-2303 Hamar, Norway;4. School of Nursing, University of Ottawa, 451 Smyth Road, Ottawa, ON K1H 8M5, Canada and: Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada;5. University of Oslo, Faculty of Medicine, Postbox 1072, Blindern, N-0316 Oslo, Norway;6. MSH Medical School Hamburg - University of Applied Sciences and Medical University, Germany;7. Faculty of Health Sciences, Department of Nursing and Health Promotion, OsloMet, Metropolitan University, Pilestredet 46, 0167 Oslo, Norway;1. Center for Health Promotions and Research, University of Texas School of Public Health, San Antonio, USA;2. Massey Cancer Center and Department of Social and Behavioral Health, Virginia Commonwealth University, Richmond, USA |
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| Abstract: | Evidence Based Medicine (EBM) and Shared Medical Decision Making (SDM) are changing the nature of health care decisions. It is broadly accepted that health care decisions require the integration of research evidence and individual preferences. These approaches are justified on both efficacy grounds (that evidence based practice and Shared Decision Making should lead to better health outcomes and may lead to a more cost-effective use of health care resources) and ethical grounds (patients’ autonomy should be respected in health care). However, despite endorsement by physicians and consumers of these approaches, implementation remains limited in practice, particularly outside academic and tertiary health care centres. There are practical problems of implementation, which include training, access to research, and development of and access to tools to display evidence and support decision making. There may also be philosophical difficulties, and some have even suggested that the two approaches (evidence based practice and Shared Decision Making) are fundamentally incompatible. This paper look at the achievements of EBM and SDM so far, the potential tensions between them, and how things might progress in the future. |
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