Healthy Skepticism Library item: 20342

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

Publication type: Journal Article

Dowie J
Decision analysis and the evaluation of decision technologies
BMJ 2001; 10:(1):1-2
http://qualitysafety.bmj.com/content/10/1/1

Abstract:

Most people have preferred ways of making judgements and decisions. When lost and not knowing what to do, some of us prefer to rely on our instinct, some on our experience based judgement. Some of us are prepared to ask our companions, some will prefer to approach people who are judged to be experts (police, newspaper vendors), and some would rather immediately consult a guide map, compass or other more analysis and evidence based guidance system. However, wherever we prefer to operate on the intuition analysis continuum,1 few of us are inclined to monitor the success of our preferred method, although our near and dear may do so and become frustrated by our obstinate refusal to change to theirs. Even fewer would be prepared to carry out an intervention based evaluation or even a less robust observational study of outcomes. So our progress around unfamiliar places is erratic and variable. However, at least it is rarely a matter of life and death and many will justify it as charming irrationality that can have serendipitous results.

Two papers published recently in Quality in Health Care—one by Timmermans and colleagues in this issue2 and the other by Robinson and Thomson on behalf of the Decision Analysis in Routine Treatments Study (DARTS) team3 which appeared in the December issue—suggest that moving towards more analytical judgement and decision making will have considerable benefits in the more serious context of medical care, particularly in the growing number of situations where alternative management strategies have significantly different consequences in terms of quantity and quality of life, or different aspects of health related quality of life. It has been—and still is in many places—traditional for the necessary value judgments to be made implicitly by clinicians without any significant attempt to establish the preferences …