Medical decisions require a thorough understanding of history of disease and the anticipated outcomes of different  treatment or management options. Patient-centered decisions incorporate patient preferences, values, and unique personal circumstances into the decision making process and actively involve patients, family members, along with health care providers. These decisions are multi-dimensional and typically involve multiple decision makers. These multi-criteria decision tools and methods are designed to help you make better choices when faced with complex decisions involving several dimensions. They are especially helpful when there is a need to combine medical data, medical information and knowledge with subjective preferences, to make trade-offs between desired outcomes.

 

Lets look at an example  Mrs. Jane Doe  a married, 50 year old mother of three owning a small stationary store. She is meeting her physician to discuss treatment of a newly diagnosed, as yet untreated chronic disease that is causing symptoms severe enough to force her to reduce the time she spends at the shop. She is aware that the disease is likely to progress and more severely interfere with her ability to manage the business, as well as  other daily activities, in the future. She  and her physician agree that some form of active treatment should be started. Fortunately, several treatment options are available. Drug A has been used for many years. It effectively alleviates symptoms, halts disease progression in two-thirds of patients, and is very well tolerated. Two newer drugs, B1 and B2, are also available. They are slightly less effective than Drug A in relieving symptoms but more effective in halting disease progression. Both drugs can cause a rare but serious side effect. Finally, there is a newly released drug, Drug C, which is reported to both alleviate symptoms and halt disease progression more effectively than any of the other available medications. However, it has higher risks of both serious and common side effects, and, because it is a new medication, could also potentially cause additional, currently unknown, adverse effects. Mrs. Doe's monthly out-of-pocket expense for Drug A would be relatively low. Her costs for the B drugs would be three to six times higher. Drug C will cost her 10 times more. How would she and her physician make a choice?  (Adapted from Multi-criteria clinical decision support: A primer on the use of multiple criteria decision making methods to promote evidence-based, patient-centered healthcare. Dolan JG)

 

Our multi-criteria decision tools are best suited ,when an ideal solution is not available, it is always unsettling to make trade-offs between the advantages and disadvantages of several imperfect alternatives, when the actual outcomes that will follow any decision are uncertain, when you need a  common language to accurately and easily discuss your decision-related preferences with each other.