Fa. Mcalister et al., Users' guides to the medical literature - XX. Integrating research evidence with the care of the individual patient, J AM MED A, 283(21), 2000, pp. 2829-2836
Citations number
76
Categorie Soggetti
General & Internal Medicine","Medical Research General Topics
Clinicians can use research results to determine optimal care for an indivi
dual patient by using a patient's baseline risk estimate, clinical predicti
on guidelines that quantitate an individual patient's potential for benefit
, and published articles. We propose that when clinicians are determining t
he likelihood that treatment will prevent the target event (at the expense
of adverse events) in a patient that they also incorporate the patient's va
lues. The 3 main elements to joint clinical decision making are disclosure
of information about the risks and benefits of therapeutic alternatives, ex
ploration of the patient's values about both the therapy and potential outc
omes, and the actual decision. In addressing the patient's risk of adverse
events without treatment and risk of harm with therapy, clinicians must rec
ognize that patients are rarely identical to the average study patient. Dif
ferences between study participants and patients in real-world practice ten
d to be quantitative (differences in degree of risk of the outcome or respo
nsiveness to therapy) rather than qualitative (no risk or adverse response
to therapy). The number needed to treat and number needed to harm can be us
ed to generate patient-specific estimates relative to the risk of the outco
me event, Clinicians must consider a patient's risk of adverse events from
any intervention and incorporate the patient's values in clinical decision
making by using information about the risks and benefits of therapeutic alt
ernatives.