Evidence in Patient-Based Decision Making
Evidence-based patient choice (EBPC) is a subset of the set of alternative frameworks that have been proposed to supplement or supplant the court-derived doctrines of consent and informed consent. In this paper, we will examine the definition, roles, and hierarchies and topologies of evidence that have been proposed to be provided to patients to use in their decision making related to the own care in health and medicine. Patient-based rational decision making in its present form has a relatively small base of high-quality medical and scientific evidence that are of potential use to patients in decision making relative to the broad range of health and medical decisions that patients face and thus is not reflective of the vast domain of decisions patients face. In addition, the proponents of alternative patient-based frameworks have not fully examined the potential impacts of evidence on patients, how evidence is to be adequately communicated to patients, and thus EBPC is still in its definitional phases of development. In this paper, we also examine a new taxonomy of patient-based decision making inclusive of a broad range of patient decisions. This taxonomy includes characteristics of four types: (1) characteristics of the decision, (2) characteristics of the patient being counseled, (3) characteristics of the patient’s counselors (providers of information and those who help clarify the unique patient’s values relative to the decision), and (4) characteristics of the evidence underlying the decision. This paper also presents a future research agenda to help fill current gaps in patientbased rational decision making relative to this taxonomy.
