Evidence Based Medicine and Shared Decision Making: The challenge of getting both evidence and preferences into health care

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Abstract

Evidence Based Medicine (EBM) and Shared Medical Decision Making (SDM) are changing the nature of health care decisions. It is broadly accepted that health care decisions require the integration of research evidence and individual preferences. These approaches are justified on both efficacy grounds (that evidence based practice and Shared Decision Making should lead to better health outcomes and may lead to a more cost-effective use of health care resources) and ethical grounds (patients’ autonomy should be respected in health care). However, despite endorsement by physicians and consumers of these approaches, implementation remains limited in practice, particularly outside academic and tertiary health care centres. There are practical problems of implementation, which include training, access to research, and development of and access to tools to display evidence and support decision making. There may also be philosophical difficulties, and some have even suggested that the two approaches (evidence based practice and Shared Decision Making) are fundamentally incompatible. This paper look at the achievements of EBM and SDM so far, the potential tensions between them, and how things might progress in the future.

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Conflict of interest

I have no conflict of interest to declare.

Acknowledgements

I would like to gratefully acknowledge the contribution of my colleagues to the ideas presented in this paper, and in particular for their contributions to the development of Fig. 1.

Professor Martin Tattersall, Department of Medicine, University of Sydney.

Dr. Lyndal Trevena, School of Public Health, University of Sydney.

Professor Chris del Mar, Dean of Medicine, Bond University.

Professor Phyllis Butow, School of Psychology, University of Sydney.

Mrs. Karen Carey-Hazell, consumer advocate, Health

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