A 64 year old woman with knee pain: case outcome
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《英国医生杂志》
1 Department of Medicine, University of Ottawa, 202-1 Stewart Street, Ottawa, Canada K1N 6N5, 2 Ottawa Health Research Institute, Ottawa Hospital, 1053 Carling Avenue, Ottawa, Canada, K1Y 4E9, 3 Cochrane Musculoskeletal Review Group, University of Ottawa
Correspondence to: ptugwell@uottawa.ca
Four weeks ago (5 June, p 1362) we presented the case of Mrs Patell, who visited her doctor after reading a newspaper article about the risks of chronic use of paracetamol with alcohol intake. Although she needed the pain relief, she was reluctant to give up alcohol. Her general practitioner discussed the benefits and harms of paracetamol versus non-steroidal anti-inflammatories and gave her a decision aid to help her clarify her decision (12 June, p 1425).
After discussing her completed decision aid with her general practitioner, Mrs Patell decided to continue the paracetamol up to 4000 mg/day. She has reduced her alcohol intake but feels that the small increase in her risk of liver disease associated with alcohol is still preferable to the even greater risk of bleeding with non-steroidal anti-inflammatories. Mrs Patell is confident in her decision and feels that she was given enough information and guidance to allow her to make an informed, value based decision.
Decision aids can benefit patients and doctors
This case is fictional but was developed from several real cases. It was commissioned to contribute to this special issue on harms.
In this case, the doctor could not clearly recommend a treatment option to the patient. The evidence of benefits and harms was not clear, and the value the patient placed on the benefits and harms was not known. The doctor recognised that Mrs Patell was uncertain about what to do but wanted to be involved in the decision making process and used a decision aid. A Cochrane systematic review of over 30 randomised trials of decision aids provides clear answers about the efficacy of decision aids.1 Compared to usual care, decision aids improve patients' knowledge of options, create realistic perceptions of the probabilities of benefits and harms, clarify personal values, enhance participation in decision making without affecting anxiety, reduce decisional conflict about the best course of action, and improve the match between what patients' value and what they choose.
We thank George Wells and Joan Peterson for help with the calculations.
Competing interests: PT received travel and research support from pharmaceutical companies. AOC receives an unrestricted research grant from the Foundation for Informed Medical Decision Making, which has a licensing agreement with Health Dialog, a company that markets decision aids.
This is the final part of a three part case report, which describes the outcome and summarises the comments made by readers during the case presentation
References
O'Connor AM, Stacey D, Entwistle V, Llewellyn-Thomas H, Rovner D, Holmes-Rovner M, et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev 2003;(2): CD001431.(Peter Tugwell, professor )
Correspondence to: ptugwell@uottawa.ca
Four weeks ago (5 June, p 1362) we presented the case of Mrs Patell, who visited her doctor after reading a newspaper article about the risks of chronic use of paracetamol with alcohol intake. Although she needed the pain relief, she was reluctant to give up alcohol. Her general practitioner discussed the benefits and harms of paracetamol versus non-steroidal anti-inflammatories and gave her a decision aid to help her clarify her decision (12 June, p 1425).
After discussing her completed decision aid with her general practitioner, Mrs Patell decided to continue the paracetamol up to 4000 mg/day. She has reduced her alcohol intake but feels that the small increase in her risk of liver disease associated with alcohol is still preferable to the even greater risk of bleeding with non-steroidal anti-inflammatories. Mrs Patell is confident in her decision and feels that she was given enough information and guidance to allow her to make an informed, value based decision.
Decision aids can benefit patients and doctors
This case is fictional but was developed from several real cases. It was commissioned to contribute to this special issue on harms.
In this case, the doctor could not clearly recommend a treatment option to the patient. The evidence of benefits and harms was not clear, and the value the patient placed on the benefits and harms was not known. The doctor recognised that Mrs Patell was uncertain about what to do but wanted to be involved in the decision making process and used a decision aid. A Cochrane systematic review of over 30 randomised trials of decision aids provides clear answers about the efficacy of decision aids.1 Compared to usual care, decision aids improve patients' knowledge of options, create realistic perceptions of the probabilities of benefits and harms, clarify personal values, enhance participation in decision making without affecting anxiety, reduce decisional conflict about the best course of action, and improve the match between what patients' value and what they choose.
We thank George Wells and Joan Peterson for help with the calculations.
Competing interests: PT received travel and research support from pharmaceutical companies. AOC receives an unrestricted research grant from the Foundation for Informed Medical Decision Making, which has a licensing agreement with Health Dialog, a company that markets decision aids.
This is the final part of a three part case report, which describes the outcome and summarises the comments made by readers during the case presentation
References
O'Connor AM, Stacey D, Entwistle V, Llewellyn-Thomas H, Rovner D, Holmes-Rovner M, et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev 2003;(2): CD001431.(Peter Tugwell, professor )