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Incorporating Patients' Preferences into Medical Decisions
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 these so-called preference-sensitive medical decisions113, 114.”
From Diabetes in Older Adults: A Consensus Report (2012) · cites this paper as [113]
In the citing paper
“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]
In the citing paper
“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]
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“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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Metadata
- 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
- 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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