Intended for healthcare professionals

Education And Debate

Patient choice modules for summaries of clinical effectiveness: a proposal

BMJ 2001; 322 doi: (Published 17 March 2001) Cite this as: BMJ 2001;322:664
  1. Margaret Holmes-Rovner, professor (,
  2. Hilary Llewellyn-Thomas, professorb,
  3. Vikki Entwistle, senior research fellowc,
  4. Angela Coulter, chief executived,
  5. Annette O'Connor, senior scientiste,
  6. David R Rovner, professor emeritusa
  1. a College of Human Medicine, Michigan State University, East Lansing MI 48823, USA
  2. b Department of Community and Family Medicine, Dartmouth Medical School, Hanover, NH 03755, USA
  3. c Health Services Research Unit, University of Abderdeen, Aberdeen AB25 2ZD
  4. d Picker Institute Europe, King's Mead House, Oxpens Road, Oxford OX1 1RX
  5. e Loeb Research Institute and Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario K1H 8M5, Canada
  1. Correspondence to: M Holmes-Rovner, B213 Clinical Center, Department of Medicine, College of Human Medicine, East Lansing, MI 48824, USA

    Evidence based health care has become the accepted basis of good clinical practice, and many efforts are being made to implement it. Evidence based patient choice, defined as offering patients research based information and the opportunity to influence decisions about their treatment and care, has yet to achieve the same status. We believe, however, that it is fundamental to high quality patient care.

    In our ideal world difficult or controversial healthcare decisions would routinely involve health professionals deliberating with patients about the harms and benefits of all available options, as well as patients' treatment goals and risk tolerance. For key medical decisions, patients and doctors would expect to work through the evidence and decide on a course of action together. Patients who wished to delegate decision making to a doctor or surrogate decision maker would still be given the information that they wanted.

    Various strategies may be needed to achieve this widespread implementation of evidence based patient choice. 1 2 In this article we focus on a strategy to improve the accessibility of information resources to support evidence based patient choice. The books, journals, and websites that currently provide evidence based information about the effectiveness of healthcare interventions could provide the infrastructure to support patients' participation in evidence based decision making. These information sources should incorporate consumer focused summaries of relevant research evidence and links or pointers to well designed and tested decision aids for patients. These summaries should be made available to patients before, during, and after consultations. Doctors and health systems could use and distribute them as an adjunct to clinical care. They would also be available to the public generally. The news and information media, patient groups, and others would draw on patient choice summaries to present the benefits and limitations of medical screening and treatment.

    Summary points

    Evidence …

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