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Evidence-informed Patient Choice


There are times when what we need is answers. Other times questions are much more important. Vikki Entwistle and her colleagues from the NHS Centre for Reviews and Dissemination have written a thoughtful and provoking piece on what they call "Evidence-informed patient choice", or EIPC [1]. EIPC or evidence-based patient choice, the alternative name, trip off the tongue, but this is an area when the brain should be engaged first. Particularly so, because in the UK at least, engaging patients in decisions about their treatments has had a much increased profile in recent years. The problems are in the hows, whys, whens and how much(e)s, and even in the definition of criteria that need to be addressed.

Criteria

Entwistle and her colleagues give three criteria for EIPC, which all have to hold:
  1. The decision is about which health care intervention(s) or pattern of care a person will or will not receive.
  2. The person concerned is given research-based information about the effectiveness (likely outcomes, both benefits and risks) of at least two alternative interventions (which may include the option of no intervention)
  3. The person concerned provides some input into the decision-making process (i.e. the decision is in some way shared between health professionals and the patient).


This definition is flexible and useful, without being proscriptive. Some might argue about the grammar, but there are always at least two options if we include doing nothing - which is an important option, as has been shown, for instance, for benign prostatic hyperplasia ( Bandolier 11 ).

Effects and thoughts

This is an impossible essay to précis. It should be read by anyone thinking about EIPC. It reviews much helpful literature, and, most of all, makes one think. And thinking before doing makes sense. Tony Hope in Oxford has also put together some useful thoughts on EIPC [2], but coming at it from a different direction, perhaps, so reading both these essays together would provide a really useful intellectual basis from which individuals or groups could proceed.

References:

  1. VA Entwistle, TA Sheldon, A Sowden, IS Watt. Evidence-informed patient choice: Practical issues involving patients in decisions about health care technologies. International Journal of Technology Assessment in Health Care 1998 14: 212-25.
  2. T Hope. Evidence based patient choice. King's Fund Publishing, London, 1996. ISBN 1 85717 129 2.



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