A problem for achieving informed choice
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.
KeywordsClassical statistics Bayesian statistics Informed choice Informed consent Randomised controlled trials
- 1.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.Google Scholar
- 5.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.
- 6.Doyal, L. 2001. Informed consent: Moral necessity or illusion? Quality in Health Care 10(supplement I): i29–i33.Google Scholar
- 9.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.CrossRefGoogle Scholar
- 10.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.Google Scholar
- 13.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.Google Scholar