Incorporating Patients' Preferences into Medical Decisions

Kassirer, Jerome P.

doi:10.1056/nejm199406303302611

Cited by 415Patient-Provider Communication in HealthcareVenous Thromboembolism Diagnosis and ManagementPalliative Care and End-of-Life Issues

Incorporating Patients' Preferences into Medical Decisions

Kassirer, Jerome P.·1994·New England Journal of Medicine

DOI 10.1056/nejm199406303302611

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Abstract

As our medical decisions become more and more standardized and codified, we should take care to ensure that critical therapeutic choices are not based exclusively on formal guidelines. Many decisions need to be individualized, especially when they involve choices between possible outcomes that may be viewed differently by different patients. In such cases we should identify a patient's preferences scrupulously -- a point underscored by O'Meara and colleagues in this issue of the Journal1. They present a decision analysis of the choice between heparin alone and streptokinase plus heparin in the treatment of deep venous thrombosis. The result helps . . .

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Shared decision-making has been advocated as an approach to improving the quality of preference-sensitive medical decisions.
“Shared decision-making has been advocated as an approach to improving the quality of these so-called preference-sensitive medical decisions113, 114.”
From Diabetes in Older Adults: A Consensus Report (2012) · cites this paper as [113]
One simulation model estimated the benefits of lowering A1C from 8.0% to 7.0% for hypothetical older diabetes patients with varying levels of age, comorbidity, and functional status.
“One such model estimated the benefits of lowering A1C from 8.0% to 7.0% for hypothetical older diabetes patients with varying levels of age, comorbidity, and functional status 113..”
From Diabetes in Older Adults: A Consensus Report (2012) · cites this paper as [113]
The model suggests that life expectancy averages less than 5 years for patients age 60-64 years with 7 additional index points, age 65-69 years with 6 additional points, age 70-74 years with 5 additional points, and age 75-79 years with 4 additional points.
“This model suggests that life expectancy averages less than 5 years for: patients age 60–64 years with 7 additional index points (points due to comorbid conditions and functional impairments), age 65–69 years with 6 additional points, age 70– 74 years with 5 additional points, and age 75–79 years with 4 additional points.”
From Diabetes in Older Adults: A Consensus Report (2012) · cites this paper as [113]
A combination of multiple comorbid illnesses and functional impairments was a better predictor of limited life expectancy and diminished benefits of intensive glucose control than age alone.
“A combination of multiple comorbid illnesses and functional impairments was a better predictor of limited life expectancy and diminished benefits of intensive glucose control than age alone.”
From Diabetes in Older Adults: A Consensus Report (2012) · cites this paper as [113]

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Authors: Kassirer, J. P.
Corresponding author: Kassirer, Jerome P.
Venue: New England Journal of Medicine
Publisher: Massachusetts Medical Society
Published: 1994-06-30
Volume: 330
Issue: 26
Pages: 1895-1896
ISSN: 0028-4793 (ISSN-L)
1533-4406
DOI: 10.1056/nejm199406303302611
OpenAlex: W2036076105
Cited by: 415
References: 24
Citations by year: 2025: 3 · 2024: 1 · 2023: 2 · 2022: 2 · 2021: 4 · 2020: 10 · 2018: 2 · 2017: 3 · 2016: 7 · 2015: 4 · 2014: 11 · 2013: 11 · 2012: 12
FWCI: 68.55
Type: journal article
Language: en
Open access: closed
Locations: New England Journal of Medicine (publishedVersion)
PubMed (publishedVersion)
DigitalGeorgetown (Georgetown University Library) (submittedVersion)
Topics: Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
Health Sciences › Medicine › Internal Medicine › Venous Thromboembolism Diagnosis and Management
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
Keywords: patient preferences, clinical guidelines, deep vein thrombosis, heparin, streptokinase, decision analysis, treatment selection
MeSH terms: Cerebral Hemorrhage, Decision Making, Heparin, Humans, Patient Participation, Postphlebitic Syndrome, Streptokinase, Thrombophlebitis, Thrombolytic Therapy, Treatment Outcome

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Incorporating Patients' Preferences into Medical Decisions

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