We thank Dobler and Marks for emphasizing the notion that the provision of individualized outcome data are a necessary but not sufficient step in the process of improving clinical decision making regarding treatment alternatives. We fully agree with the value of using decision analysis to prioritize clinical scenarios most in need of further data and on the importance of basing decisions on patient-centered outcomes. Moreover, we support the authors' assertions regarding the need to elicit patient preferences. Numerous studies have demonstrated that the preferred option will vary among well-informed patients, even when one strategy is recommended by experts or shown to be superior in analytic decision models. Therefore, high-quality decision making requires not only the availability of appropriately tailored outcome data but also an explicit assessment of how individual patients value the outcomes associated with different treatment alternatives.
Fraenkel L, Fried T. Medical Decision Making at the Individual Patient Level—Reply. Arch Intern Med. 2010;170(14):1275-1276. doi:10.1001/archinternmed.2010.242