CHOICE AND ELICITATION OF PREFERENCES, TO WARD THERAPEUTIC DECISION SHARING IN CANCEROLOGY - FROM ECONOMIC-THEORY TO MEDICAL-PRACTICE

Today, as it is often difficult to demonstrate the superiority of a ne w molecule or a therapeutic strategy in term of plain efficacy on dise ase, the incitement is strong to provide some complementary argument o f assessment, we are assisting to the emergence of a new concept: shar ed therapeutic decision making. Is the application of this concept - w ich make the paternalistic model questionable - adapted to all cases? What are the different levels of participation that could be envisaged ? Are there favourable methods for this participation? This shared dec ision making - direct (patients' choice between treatment options) or indirect (integration of elicited preferences in the decision process) - if it has to be efficient, must surround with care: to define its a pplication limitation, to protect itself of manipulation. It shall req uire to consider infirmation transmission difficulties, to establish s ome elicitation preference method. Some technical, such as time trade off, standard gamble or willingness to pay, supported by economic theo ry of expected utility, permit to help eliciting patients' preferences and to structure the therapeutic choice. Some empirical study of pref erence elicitation shall permit to get clear the complexity of trade o ff between the different choice element that could enter in the accept ability of the treatment for patients.