Engaging Patients in Evidence Review to Make Decisions?

Knowledge translation into clinical practice is especially challenging when research evidence changes. Twenty years of randomized trials show that percutaneous coronary intervention or PCI (balloon angioplasty and stents) with medical therapy is no more effective than medical therapy alone for reducing heart attack rates or improving survival. However, a definitive diagnosis requires an angiography (heart catheterization), and efficiency suggests a PCI should be done at the same time. How should doctors and patients decide where in the diagnostic/therapeutic cascade to stop? Should payers be allowed to alert patients to potential over-use? Is shared decision making likely to improve care, improve outcomes, improve utilization, or simply shift the burden of choice to patients?
Margaret Holmes-Rovner, PhD
Professor in the Center for Ethics and Humanities in the Life Sciences and Department of Medicine at MSU
Recorded October 13, 2010