July 17, 2015

What is best for me and my family? A union of forces for patient-centered care

By Victor M. Montori

Does it make sense to hold a shared decision-making conference and an evidence-based healthcare conference together? Reflections before Sydney 2015


From July 19-22, 2015, the International Society for Evidence-based Healthcare (ISEHC) and the International Shared Decision Making Conference will meet together, for the first time, in Sydney.


Our groups have been hatching this moment for years. In addition to the reduced carbon footprint and other efficiencies, there is a conceptual case for this. This was first elaborated in Peru ISDM 2013 by Gordon Guyatt who coined ‘evidence-based medicine’ and is the president of ISEHC. Later, a paper in JAMA with my colleagues in Australia further the connection between EBM and SDM.  Here are my reflections before traveling to Sydney.


A paradigm shift in medicine that extended to the rest of health care started 25 years ago. Evidence-based healthcare (EBHC) promoted a systematic appreciation of the body of knowledge about the options of care and their relative merits. It sought to explicitly incorporate this knowledge in the design of clinical care policies and in the care of individual patients. EBHC recognized that consideration of the research evidence alone is necessary but not sufficient to formulate a sensible recommendation. Patient preferences and context – personal, social, and clinical – must be explicitly considered to increase the chance that we will do more good than harm. Without this context, we have evidence tyranny, a careless one-size-fits-all nightmare.


In parallel, work has taken place to center care around patients, through advocacy, collective action, and science. Nothing about me without me. This work has led, at best, to favor patient empowerment, activation, and self-care; at worse, it has casted patients as customers and consumers. When they bring the patient into sharper focus, these approaches, however, often leave implicit how to use the evidence to formulate care plans that address the patient situation.


More enlightened approaches have sought to engage patients in co-creating decisions. Patients and clinicians need options based on science, and they need to put the pertinent evidence to work to attend to this patient’s situation. Overcoming the allure of evidence tyranny, we must embrace the messy work of making use of the evidence to care for patients, and to partner with them to co-create treatments that address their particular situations. It is work that patients and clinicians undertake together.


The work of evidence-based healthcare and shared decision making supports patients and clinicians in jointly finding an adequate answer, in this time and place, to a driving question of health care: what is best for me and my family? In responding, they configure a powerful union of forces for patient-centered care.


I look forward to experiencing this union of forces down under!

Tags: evidence based medicine, Evidence based medicine, International Shared Decision Making Conference, International Society for Evidence-based Healthcare, sdm, shared decision making, Shared decision making

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