8/31/2023 0 Comments Evidence based decision making![]() ![]() ![]() ![]() In this Idea we consider whether managers are making the facts-based decisions they seek to make. Sometimes evidence-based decision-making is less appropriate than decision-based evidence making.ĭecision-making is perhaps the essence of management, and much attention continues to be focused on how to do it better. Although, as explained in this Idea, there are certain times when this is not necessarily a bad thing. A clear understanding of the roles evidence can play in making a decision can help avoid this. Just as often though, and sometimes without realizing it, managers are fitting the evidence to the decision they’ve already made in fact ‘ decision-based evidence making’. Additionally, many entities that publish guidelines require that only randomized trial data be used, which is often a significant limitation.One of the ways we strive to make a good decision is through evidence-based decision-making. To incorporate uncertainty and the value of outcomes into clinical decision making, clinicians must often apply the principles of quantitative or analytical medical decision making (see also Clinical Decision-Making Strategies Clinical Decision-Making Strategies One of the most commonly used strategies for medical decision making mirrors the scientific method of hypothesis generation followed by hypothesis testing. Furthermore, guidelines do not take into account the degree of uncertainty inherent in test results, the likelihood of treatment success, and the relative risks and benefits of each course of action. Guidelines and algorithms are generally straightforward and easy to use but should be applied only to patients whose clinical characteristics (eg, demographics, comorbidities, clinical features) are similar to those of the patient group used to create the guideline. More complex, multistep rules may be formalized as algorithms. Some clinical guidelines follow “if, then” rules (eg, if a patient is febrile and neutropenic, then institute broad-spectrum antibiotics). Limitations of the evidence-based approach Two general concerns are that patients who voluntarily participate in clinical trials are not the same as patients in general practice, and care delivered in a clinical trial environment is not identical to general care in the medical community. The cost of tests and treatments may also influence physician and patient decision making, especially when some of the alternatives are significantly costlier for the patient. ![]() For example, even though an EBM review may definitively show a 3-month survival advantage from an aggressive chemotherapy regimen in a certain form of cancer, patients may differ on whether they prefer to gain the extra time or avoid the extra discomfort. Additionally, patients’ wishes regarding aggressive or invasive tests and treatment must be taken into account as well as their tolerance for discomfort, risk, and uncertainty. Evidence-Based Medicineīecause the best available evidence may have come from patient populations with different characteristics from those of the patient in question, significant judgment is required when applying results from a randomized trial to a specific patient. EBM is built on reviews of relevant medical literature and follows a discrete series of steps. These variations have led to a call for a more systematic approach to identifying the most appropriate strategy for an individual patient this approach is called evidence-based medicine (EBM). Variations exist among different countries, different regions, different hospitals, and even within individual group practices. This kind of practice results in wide variations in strategies for diagnosing and managing similar conditions, even when strong evidence exists for favoring one particular strategy over another. However, for many clinicians, the “evidence” is often a vague combination of recollected strategies effective in previous patients, advice given by mentors and colleagues, and a general impression of “what is being done” based on random journal articles, abstracts, symposia, and advertisements. Physicians have always felt that their decisions were based on evidence thus, the current term “evidence-based medicine” is somewhat of a misnomer. ![]()
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