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Resource Corner

Decision Making in Health and Medicine. Integrating Evidence and Values

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ACP J Club. 2005 Mar-Apr;142:A11. doi:10.7326/ACPJC-2005-142-2-A11



Decision Making in Health and Medicine supersedes the highly respected text, Clinical Decision Analysis, by Weinstein, Fineberg, Elstein, and colleagues published in 1980. Its main purpose is to provide insights and tools that can aid decision making in health care. In this, like its predecessor, it eminently succeeds. The flyer makes the bold claim that the user-friendly text will help everyone involved in health care and medical decision making, specifically practitioners, trainees, and students studying clinical decision analysis, evidence-based medicine, and clinical epidemiology. Although a little hyperbole is to be expected, this description has serious potential to mislead. Despite being extremely well written and structured and furnished with a wealth of supporting information on the accompanying CD-ROM, size alone makes the book an inappropriate place to start for those wanting an introduction to decision support techniques. It is appropriate as a text to support attempts to do decision analysis. Some familiarity with the concepts of decision analysis are required to make the most of this book.

There is no information on how the resource was compiled, although such information would be unusual for a methodological publication. It is debatable just what it might have added and whether greater explicitness might be appropriate for future editions. However, it was frustrating that the tools described had changed from those in Weinstein and colleagues' Clinical Decision Analysis, and there was no discussion on what prompted these changes.

The book contains 12 chapters:

“Elements of decision making in health care” is an initial overview

“Managing uncertainty” explores the fundamental rules of probability and the concept of expected utility

“Choosing the best treatment” explains the use of decision trees to determine the best treatment under conditions of diagnostic uncertainty

“Valuing outcomes” outlines utility assessment

“Interpreting diagnostic information”; “Deciding when to test”; and “Multiple test results” deal with sequentially more sophisticated tools concerning decisions relating to tests, starting with Bayes' theorem

“Finding and summarizing the evidence” discusses tools for identifying the best available data and managing their limitations

“Constrained resources” introduces the tools of cost-effectiveness and cost-utility analysis

“Recurring events” and “Variability and uncertainty” are 2 chapters introducing modelling techniques, including Markov models and Monte Carlo simulation

“Proactive decision making: a way of life” concludes by revisiting the steps of clinical decision making represented by the PROACTIVE mnemonic

The accompanying CD-ROM contains solutions to exercises (the approach to imminent Markov madness in chapter 10 is particularly appreciated!), decision analytic software, examples of the decision models, supplementary materials including useful spreadsheets, and references with abstracts.

This is not a resource designed to directly provide clinically useful answers. But such answers would undoubtedly flow from clinicians or policymakers equipped with the skills the book seeks to impart. It is difficult to dip into without a clear overall understanding of the subject, but this might well be gained initially by reading the book in its entirety. In contrast to many textbooks, the readability, effective structure, and well-chosen illustrative examples make such a cover-to-cover journey feasible. I will certainly use the resource and will recommend it to Master's level students—I do not anticipate much use at the undergraduate level. Given the growing importance of the tools described in this book, the need for an introductory text or article suitable at the undergraduate level is highlighted.

Decision Making in Health and Medicine is an excellent resource dealing with the conduct of increasingly important and ubiquitous decision aids, but is not suitable as an introduction to them.

Chris Hyde, MBBS, MRCP, MFPHM
University of Birmingham
Birmingham, England, UK

Decision Making in Health and Medicine can be purchased online at www.us.cambridge.org for U.S. $65.00.

Hunink M, Glasziou P. Decision Making in Health and Medicine. Integrating Evidence and Values. Cambridge: Cambridge University Press; 2001.