A colleague recently forwarded me this really interesting NEJM article, which reflects a growing trend toward incorporating patient preference in our clinical guidelines. It may seem funny to patients that this is a novel idea; of course we ought to be concerned about patient preference. Yet almost all of our recommendations as physicians combine our medical knowledge with some sort of value judgment.
These value judgments are general assumptions of what’s in the best interest of the patient. Most judgments are reasonable and uncontroversial; recommending an antibiotic for a urinary tract infection, for example, assumes that you would rather take a pill for a few days than tough it out and risk a worsening infection.
Some value judgments however are more controversial. Take statins, for example. Statins can reduce a patient’s risk of having a heart attack or stroke. However, the overall benefit is usually small, especially in low-risk individuals: it requires many individuals to take these pills for many years to notice a difference.
Consequently, the medical community has had trouble agreeing on this simple question: does it make sense for a generally healthy individual to take one of these pills every day for several years?Patient decision aid tools incorporate patient preference in medical decision-making (without extending visits) Click To Tweet
It’s paternalistic of us to decide without taking into account the individual patient’s values. Do they hate taking pills every day? How worried are they about the side effects? Obviously these concerns matter, but with limited time available for discussion during office visits, they are often left unaddressed.
The end result is a patient explaining to their partner, “my doctor says I’m supposed to take this pill every day”. I would much rather have them say, “I’m taking this pill every day because it’s worth it to me to lower my risk of having a heart attack.”
So how do we better incorporate the patient’s preference in the medical decision-making process?
Taking a little more time to explain our recommendations is the obvious way to help ensure patient preference is considered in the medical decision-making process. However, with the constant pressure to stay on schedule, this can be easier said than done. Fortunately, technology provides a new strategy: we can start incorporating apps and other patient-engagement tools in our practice.
With this in mind I built a new statin decision aid tool for the Ocean platform. It introduces patients to the concept of statins, the magnitude of their benefit (depending on a patient’s individual risk), discusses side effects, alternatives, and so on.
Do you have other ideas for tools that could benefit from this approach? Let us know!