Author Affiliations: Division of General Internal Medicine, University of Alberta Hospital, Edmonton (Dr McAlister); Division of General Internal Medicine, Mount Sinai Hospital–University Health Network, Toronto (Dr Straus), and Department of Clinical Epidemiology and Biostatistics and Department of Medicine, McMaster University, Hamilton, Ontario (Drs Guyatt and Haynes).
Users' Guides to the Medical Literature Section
Editor: Drummond Rennie, MD, Deputy Editor.
Clinicians can use research results to determine optimal care for an
individual patient by using a patient's baseline risk estimate, clinical prediction
guidelines that quantitate an individual patient's potential for benefit,
and published articles. We propose that when clinicians are determining the
likelihood that treatment will prevent the target event (at the expense of
adverse events) in a patient that they also incorporate the patient's values.
The 3 main elements to joint clinical decision making are disclosure of information
about the risks and benefits of therapeutic alternatives, exploration of the
patient's values about both the therapy and potential outcomes, and the actual
decision. In addressing the patient's risk of adverse events without treatment
and risk of harm with therapy, clinicians must recognize that patients are
rarely identical to the average study patient. Differences between study participants
and patients in real-world practice tend to be quantitative (differences in
degree of risk of the outcome or responsiveness to therapy) rather than qualitative
(no risk or adverse response to therapy). The number needed to treat and number
needed to harm can be used to generate patient-specific estimates relative
to the risk of the outcome event. Clinicians must consider a patient's risk
of adverse events from any intervention and incorporate the patient's values
in clinical decision making by using information about the risks and benefits
of therapeutic alternatives.
McAlister FA, Straus SE, Guyatt GH, Haynes RB, for the Evidence-Based Medicine Working Group. Users' Guides to the Medical Literature: XX. Integrating Research Evidence With the Care of the Individual
Patient. JAMA. 2000;283(21):2829–2836. doi:10.1001/jama.283.21.2829
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