A problem for achieving informed choice
- Adam La Caze
- … show all 1 hide
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Most agree that, if all else is equal, patients should be provided with enough information about proposed medical therapies to allow them to make an informed decision about what, if anything, they wish to receive. This is the principle of informed choice; it is closely related to the notion of informed consent. Contemporary clinical trials are analysed according to classical statistics. This paper puts forward the argument that classical statistics does not provide the right sort of information for informing choice. The notion of probability used by classical statistics is complex and difficult to communicate. Therapeutic decisions are best informed by statistical approaches that assign probabilities to hypotheses about the benefits and harms of therapies. Bayesian approaches to statistical inference provide such probabilities.
- Elwyn, G., A. Edwards, P. Kinnersley, and R. Grol. 2000. Shared decision making and the concept of equipoise: The competencies of involving patients in healthcare choices. British Journal of General Practice 50(460): 892–899.
- Savulescu, J., and R.W. Momeyer. 1997. Should informed consent be based on rational beliefs? Journal of Medical Ethics 23(5): 282–288. CrossRef
- Tversky, A., and D. Kahneman. 1974. Judgement under uncertainty: Heuristics and biases. Science 185(4157): 1124–1131. CrossRef
- Epstein, R.M., B.S. Alper, and T.E. Quill. 2004. Communicating evidence for participatory decision making. Journal of American Medical Association 291(19): 2359–2366. CrossRef
- World Medical Association. 1964 (Last updated 2004). World Medical Association Declaration of Helsinki: Ethical principles for medical research involving human subjects. http://www.wma.net/e/policy/b3.htm. Accessed 4 June 2008.
- Doyal, L. 2001. Informed consent: Moral necessity or illusion? Quality in Health Care 10(supplement I): i29–i33.
- Kottow, M. 2004. The battering of informed consent. Journal of Medical Ethics 30(6): 565–569. CrossRef
- Ford, S., T. Schofield, and T. Hope. 2003. What are the ingredients for a successful evidence based patient choice consultation? A qualitative study. Social Science & Medicine 56: 589–602. CrossRef
- Man-Son-Hing, M., A. Laupacis, A. O’Connor, J. Biggs, E. Drake, E. Yetisir, and R. Hart. 1999. A patient decision aid regarding antithrombotic therapy for stroke prevention in atrial fibrillation: A randomised controlled trial. Journal of American Medical Association 282(8): 737–743. CrossRef
- Edwards, A., and G. Elwyn. 2001. Understanding risk and lessons for clinical communication about treatment preferences. Quality in Health Care 10(supplement I): i9–i13.
- Col, N.F., G. Weber, A. Stiggelbout, J. Chuo, R. D’Agostino, and P. Corso. 2004. Short-term menopausal hormone therapy for symptom relief: An updated decision model. Archives of Internal Medicine 164: 1634–1640. CrossRef
- Edwards, A., G. Elwyn, and A. Mulley. 2002. Explaining risks: Turning numerical data into meaningful pictures. British Medical Journal 324(7341): 827–830. CrossRef
- Ware, J.H., F. Mosteller, F. Delgado, C. Donnelly, and J.A. Ingelfinger. 1992. P values. In Medical uses of statistics, ed. John C. Bailar III and Frederick Mosteller, 181–200. Boston: NEJM Books.
- Atrial Fibrillation Investigators. 1994. Risk factors for stroke and efficacy of antithrombotic therapy in atrial fibrillation. Archives of Internal Medicine 154: 1449–1457. CrossRef
- The SPAF III Writing Committee for the Stroke Prevention in Atrial Fibrillation Investigators. 1998. Patients with nonvalvular atrial fibrillation at low risk of stroke during treatment with aspirin. Journal of the American Medical Association 279: 1273–1277. CrossRef
- Home, P.D., S.J. Pocock, H. Beck-Nielsen, R. Gomis, M. Hanefeld, N.P. Jones, M. Komajda, J.J.V. McMurray, and The Record Study Group. 2007. Rosiglitazone evaluated for cardiovascular outcomes—an interim analysis. New England Journal of Medicine 357(1): 28–38. CrossRef
- Drazen, J.M., S. Morrissey, and G.D. Curfman. 2007. Rosiglitazone—continued uncertainty about safety. New England Journal of Medicine 357(1): 63–64. CrossRef
- Berry, D.A. 2006. Bayesian clinical trials. Nature Reviews Drug Discovery 5(1): 27–36. CrossRef
- Poole, C. 2001. Low p-values or narrow confidence intervals: Which are more durable? Epidemiology 12(3): 291–294. CrossRef
- Young, J.M., P. Glasziou, and J.E. Ward. 2002. General practitioners’ self ratings of skills in evidence based medicine: validation study. British Medical Journal 324(7343): 950–951. CrossRef
- Berger, J.O., and T. Sellke. 1987. Testing a point null hypothesis: The irreconcilability of p-values and evidence. Journal of the American Statistical Association 82(397): 112–122. CrossRef
- A problem for achieving informed choice
Theoretical Medicine and Bioethics
Volume 29, Issue 4 , pp 255-265
- Cover Date
- Print ISSN
- Online ISSN
- Springer Netherlands
- Additional Links
- Classical statistics
- Bayesian statistics
- Informed choice
- Informed consent
- Randomised controlled trials
- Adam La Caze (1)
- Author Affiliations
- 1. Philosophy Department, Main Quad, University of Sydney, Sydney, 2006, Australia