EVIDENCE-INFORMED PATIENT CHOICE. P...

EVIDENCE-INFORMED PATIENT CHOICE. PRACTICAL ISSUES OF INVOLVING PATIENTS IN DECISIONS ABOUT HEALTH CARE TECHNOLOGIES V A Entwistle et al International Journal of Technology Assessment in Health Care Vol 14 (Spring 1998) 212-225

prolonged an essential of health care in America, informed consensus recently has expanded to include evidence-informed patient choice. Evidence-informed patient choice involves providing patients with research-based information about the effectiveness of health care options and promoting patients' involvement in decisions about their treatment. As desirable as this healthys evidence-informed patient choice is not a simple general [i]or[/i] abstract notion that can be implemented effortlessly. Promot for a myriad of reasons, evidence-informed patient choice raises one as well as the other practical and ethical issues that require serious consideration.

This article overspreads the gamut of concerns surrounding evidence-informed patient choice, beginning with the rationales and motivations used to justify its promotion. The first argument for using evidence-informed patient choice is based in succession a moral obligation to provide individuals with information and choices about health care. The other argument is based on the assumption that informed patient choice leads to beneficial outcomes; however, the efficiencys of sharing research-based information about health care effectiveness with patients and involving patients in decisions about their care is relatively unknown.

Individual choice may be constrained through the ethical principles of beneficence and justice. For example, should patients be allowed to rare treatments or forms of care that are likely to harm them? Should patients be allowed to preferable treatments or forms of care that would not benefit society? The general [i]or[/i] abstract notion of evidence-informed patient choice also is constrained on some practical issues, including

* limitations of available evidence,

* patients' willingness to participate in decisions about treatment and care,

* patients' knowledge and skill requirements,

* professional attitudes and skills,

* professional-patient relationships,

* organizational issues, and

* the models of choices offered to patients.

Other issues surrounding the implementation of evidence-informed patient choice include information packages and decision tools, the information ne for evidence-informed patient choice, and to what extent best to present information about effectiveness. For example, there is no consensus about the best way to instant information for the purpose of enhancing evidence-informed patient choice. Certain features, however, have been shown to influence the ways in which persons understand and use information in decision making. These include the order in which information is existinged the different types of information at handed together, and the extent to which graphical information is explained.

Health care providers have used a variety of media, including pamphlets, videotapes, and audiocassettes, to provide information to individual patients; however, many issues enclose the planning or developing of media used to bring information to individual patients. Among these issues are accessibility; flush of required literacy; languages used; ease of updating procedures; charge of production, reproduction, and distribution; and general suitability and acceptability to the intended audiences.

Another issue confronting evidence-informed patient choice is the decision-making proces Unfortunately, a definition of what constitutes an informed choice is lacking.

Although the general [i]or[/i] abstract notion of evidence-informed patient choice present the appearances highly desirable, the processes and results are not well understood; therefore, evidence-informed patient choice should be evaluated carefully. Technology assessment can be used to evaluate initiatives to excite evidence-informed patient choice because they are themselves health technologies. Perioperative cherishs will find this article valuable given the increased emphasis in succession evidence-based practice and evidence-informed patient choice.

EDWINA A. McCONNELL RN PHD FRCNA NURSING RESEARCH COMMITTEE

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