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PRIMARY CARE: Elizabeth Murray, Hilary Davis, Sharon See Tai, Angela Coulter, Alastair Gray, and Andy Haines Randomised controlled trial of an interactive multimedia decision aid on hormone replacement therapy in primary care BMJ 2001; 323: 490 [Abstract] [Full text]

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Answering the right question on decision aids.

Philip Zack   (5 September 2001)

Sharing uncertainty

John Hopkins   (5 September 2001)

Answering the right question on decision aids. 5 September 2001
Philip Zack, Clinical Research Fellow Institute of Child Health Send response to journal: Re: Answering the right question on decision aids.	Murray and her colleagues rightly make the distinction between 'simple information' and information framed in such as way as to make it a 'decision aid'. However,I would suggest that their studies then go on, by their choice of control group, to fail to answer their own question. If the question was 'Does a decision tool (rather than any other kind of information) help decision-making?' then the appropriate control should be information NOT formatted as a decision aid. As they stand, these studies do not show that decision-aids help decision-making, merely that information helps (the fact that it was formatted as a decision aid may or may have been relevant to it's effect). Would a simple, cheap information booklet have lead to the same (or perhaps even superior) decision outcome? That information aids decision making is almost axiomatic. However, the more important issue is surely to ask what features of the information aid decision-making (turning information into knowledge). Interactivity and other features may be important, but in order the answer the question the effects of different information formats must surely be compared.
Sharing uncertainty 5 September 2001
John Hopkins, General practitioner Darlington Send response to journal: Re: Sharing uncertainty	Dear Sir, Public enthusiasm for medical web sites (1) is often based on the assumption that information is power. By gaining access to a secret garden of medical insight, it is argued, patients will be better able to negotiate on equal terms with doctors. Up to a point perhaps, but sharing knowledge also means facing up to the limitations of medicine. Most medical practice is about the use of a few tried and tested drugs and the proper application of surgical skills. No amount of software will change that. Yours sincerely, John Hopkins (1) E Murray, H Davis, S Tai, A Coulter, A Gray and A Haines Randomised controlled trial of an interactive multimedia decision aid on hormone replacement therapy in primary care BMJ 2001 323:493