EVIDENCE AND DECSION MAKING



How Is Evidence Used To Inform Decision Making In Health Care Settings



How Is Evidence Used To Inform Decision Making In Health Care Settings

Introduction

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. (Davies? 2001? 33-41) 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.

Describe the principles of Evidence Based Health and Health Care

While the precautionary principle originated in the context of environmental and global policies? there is a discussion nowadays whether this principle is also applicable to other settings? including medicine and health care. To get a better view of the possible applicability? we should take a closer look of the moral principles which are generally supposed to guide medical decision making. (Davies? 2001? 33-41)

The precautionary principle could be seen as a re-formulation of the principle of nonmaleficence? which is one of the main principles of medical practice. According to Beauchamp and Childress (2001)? the principle of nonmaleficence asserts an obligation not to inflict harm on others. The principle is closely associated with the maxim premium non nicer? which means 'above all do not harm' (Beauchamp and Childress? 2001). The principle of nonmaleficence is generally distinguished from the principle of beneficence? which establishes an obligation to act for the benefit of others.

This principle is often regarded as less obligatory than the principle of nonmaleficence. (Davies? 2001? 33-41)

In medical ethics both principles are seen as linked with each other: doctors (or other care providers) have an obligation to act in the interest of the patient? but generally can only do so by inflicting a certain amount of harm. For example? when a patient has a gangrenous leg? he or she can only be saved when the leg is amputated. Another example is the treatment of appendicitis? which in most cases consists of an appendectomy? that is? surgical intrusion into the body and removal of the appendix.

In medical ethics then? the principle of nonmaleficence is interpreted as the obligation not to do unnecessary harm: if harm has to be done in order to ...