A conditional model of evidence-based decision making
Version of Record online: 23 DEC 2009
© 2009 Blackwell Publishing Ltd
Journal of Evaluation in Clinical Practice
Special Issue: Evidence Based Medicine
Volume 15, Issue 6, pages 1142–1151, December 2009
How to Cite
Falzer, P. R. and Garman, M. D. (2009), A conditional model of evidence-based decision making. Journal of Evaluation in Clinical Practice, 15: 1142–1151. doi: 10.1111/j.1365-2753.2009.01315.x
- Issue online: 23 DEC 2009
- Version of Record online: 23 DEC 2009
- Accepted for publication: 12 August 2009
- chronic illness;
- clinical judgement;
- decision making;
- evidence-based medicine;
- mental illness;
- treatment guidelines
Rationale, aims and objectives Efforts to describe how individual treatment decisions are informed by systematic knowledge have been hindered by a standard that gauges the quality of clinical decisions by their adherence to guidelines and evidence-based practices. This paper tests a new contextual standard that gauges the incorporation of knowledge into practice and develops a model of evidence-based decision making. Previous work found that the forecasted outcome of a treatment guideline exerts a highly significant influence on how it is used in making decisions. This study proposed that forecasted outcomes affect the recognition of a treatment scenario, and this recognition triggers distinct contextual decision strategies.
Methods Twenty-one volunteers from a psychiatric residency programme responded to 64 case vignettes, 16 in each of the four treatment scenarios. The vignettes represented a fully balanced within-subjects design that included guideline switching criteria and patient-specific factors. For each vignette, participants indicated whether they endorsed the guideline's recommendation.
Results Clinicians used consistent contextual decision strategies in responding to clearly positive or negative forecasts. When forecasts were more ambiguous or risky, their strategies became complex and relatively inconsistent.
Conclusion The results support a three-step model of evidence-based decision making, in which clinicians recognize a decision scenario, apply a simple contextual strategy, then if necessary engage a more complex strategy to resolve discrepancies between general guidelines and specific cases. The paper concludes by noting study limitations and discussing implications of the model for future research in clinical and shared decision making, training and guideline development.