Assignment: Decision Aids Standards

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Assignment: Decision Aids Standards

Assignment: Decision Aids Standards

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Another place to start to bring EBM and SDM together is the development and implementation of clinical practice guidelines. Whereas most guidelines fail to consider patients’ preferences in formulating their recommendations,6 some advise clinicians to talk with patients about the options but provide no guidance about how to do this and communicate the evidence in a way patients will understand. Shared decision making may be strongly

recommended in guidelines when the options are closely matched in their advantages and disadvantages, when uncer- tainty in the evidence impairs determination of a clearly superior approach, or when the balance of benefits and risks depends on patient action, such as adherence to medication, monitoring, and diet in patients using warfarin.

Conclusions Links between EBM and SDM have until recently been largely ab- sent or at best implied. However, encouraging signs of interaction are emerging. For example, there has been some integration of the teaching of both,7 exploration about how guidelines can be adapted to facilitate SDM,8,9 and research and resource tools that recog- nize both approaches. Examples of the latter include research agenda and priority setting occurring in partnership with patients and cli- nicians to help provide relevant evidence for decision making; and a new evidence criterion for the International Patient Decision Aids Standards requiring citation of systematically assembled and up- to-date bodies of evidence, with their trustworthiness appraised,10

thus aligning the development of SDM tools with contemporary re- quirements for the formulation of evidence-based guidelines. Also, independent flagship conferences focused on the practice of evi- dence-based health care and on the science of shared decision mak- ing are now convening joint meetings.

Medicine cannot, and should not, be practiced without up-to- date evidence. Nor can medicine be practiced without knowing and respecting the informed preferences of patients. Clinicians, researchers, teachers, and patients need to be aware of and actively facilitate the interdependent relationship of these approaches. Evidence-based medicine needs SDM, and SDM needs EBM. Patients need both.

ARTICLE INFORMATION

Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Montori reported serving on the board of the International Society for Evidence-based Healthcare; serving as Chair of the Seventh International Shared Decision Making Conference in 2013; that he is a member of the Steering Committee of the International Patient Decision Aids Standards; and that he is a member of the GRADE Working Group. The KER Unit (Dr Montori’s research group) produces and tests evidence-based shared decision making tools that are freely available at http://shareddecisions.mayoclinic.org. Dr Hoffmann reported that she is supported by a National Health and Medical Research Council of Australia (NHMRC)/Primary Health Care Research Evaluation and Development Career Development Fellowship (1033038), with funding provided by the Australian Department of Health and Ageing. Drs Hoffmann and Del Mar reported that they are coeditors of a book on evidence-based practice, for which they receive royalties.

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