In the first paper, Dale Collins Vidal of the Dartmouth Institute for Health Policy and Clinical Practice points out that the current informed consent process fails to help patients understand the trade-offs—or specific risks and benefits—in comparing treatment options. When competing treatment options are “preference sensitive,” decision making about treatment should incorporate a patient’s values and preferences. To ensure that patients have the tools they need to make an informed choice, providers must adequately communicate the risks, benefits, alternatives, experience, and cost.
In the second paper, Clifford Goodman of The Lewin Group addresses the limitations of evidence hierarchies that have been used for decades. He highlights the limitations of what until now has been considered “best evidence,” for example, meta-analyses and randomized controlled trials (RCTs). He suggests moving away from RCTs as best evidence for a number of reasons, including their focus on population-based care, the time lag in obtaining scientific results, high costs, and the lack of applicability to individual patients. He points to several methods that can better capture evidence applicable to personalized medicine, which is becoming increasingly important with advances in genomic data.
Fran M. Visco of the National Breast Cancer Coalition addresses translating and communicating evidence when the recommendations for care are uncertain. She reviews the barriers to understanding science-driven care, including the adoption of practices that have become standard even though evidence to back them is limited; the oversimplification of messaging that misleads the public; and the promulgation of guidelines that are self-serving. She highlights the pressing need to evaluate how to deliver complex messages about interventions so they can be made pertinent to individual patients.
Dale Collins Vidal, M.D., M.S.1
Dartmouth Institute for Health Policy and Clinical Practice
In Crossing the Quality Chasm, the Institute of Medicine (IOM) defines patient-centeredness as “providing care that is respectful of and responsive to individual patient preferences, needs, and values, ensuring that patient values guide all clinical decisions” (IOM, 2001). However, studies reveal that the current informed consent process falls far short of this goal and frequently fails to help patients understand the specific risks and benefits of
1 The author would like to acknowledge Allison J. Hawke, Sue Burg, and Sherry Thornburg for their contributions in preparing this manuscript.