The article discusses the basis for this quandary, providing examples of the real-world impact it has on diagnosis-seeking and treatment decision-making behaviors and how it might inform implementation of EBM practices. Siminoff, L (2013).  Incorporating patient and family preferences into evidence-based medicine.  BMC Med Infom Decis Ma 13 (Suppl 3)  S6 doi: Purchase the answer to view it

Incorporating patient and family preferences into evidence-based medicine (EBM) has been a topic of discussion and debate in recent years. EBM is an approach to medical decision-making that emphasizes the integration of the best available evidence with clinical expertise and patient values and preferences. However, there has been a recognized tension between the emphasis on evidence and the incorporation of patient preferences in decision-making.

This quandary arises from the belief that evidence-based medicine should prioritize objective scientific evidence in determining the best course of action for individual patients. The supporters of this approach argue that patients’ preferences should be secondary to the scientific evidence, as patients may have limited knowledge and understanding of their condition or may be influenced by emotions or biases.

On the other hand, there is a growing recognition that patient preferences and values play a crucial role in medical decision-making. Patients bring their unique perspectives, values, and goals to the decision-making process, and these factors can impact their treatment choices. Ignoring or dismissing patient preferences may result in decisions that do not align with their values, leading to dissatisfaction, non-compliance with treatment, and poorer health outcomes.

The article by Siminoff (2013) delves into this topic, providing insight into the real-world impact of incorporating patient and family preferences into evidence-based medicine. The author highlights the challenges faced by patients and their families in seeking a diagnosis and making treatment decisions. These challenges include difficulties understanding and interpreting medical information, conflicting opinions from healthcare providers, and competing priorities and values among family members.

One example cited in the article is the case of a patient diagnosed with breast cancer. The patient had a strong preference for a less aggressive treatment approach, based on her personal values and quality of life considerations. However, she encountered resistance from her healthcare providers, who believed that the evidence supported a more aggressive treatment approach. This mismatch between the patient’s preference and the recommended treatment created a significant dilemma for the patient and her family.

The article also discusses the role of patient preferences in shared decision-making, where patients and healthcare providers work together to make treatment decisions. Shared decision-making recognizes that patients have a right to be involved in their care and that their preferences should be considered. It acknowledges that different patients may have different priorities and values and that treatment decisions should reflect these individual differences.

However, incorporating patient preferences into evidence-based medicine is not without challenges. The article highlights potential barriers to incorporating patient preferences, including time constraints, lack of training in communication skills and shared decision-making, and the difficulty of integrating patient preferences into clinical practice guidelines.

Despite these challenges, there are several reasons why incorporating patient and family preferences into evidence-based medicine is important. First and foremost, it honors the principles of patient-centered care, ensuring that decisions are aligned with the patient’s values and goals. This can lead to increased patient satisfaction and adherence to treatment.

Second, it recognizes the importance of individualized care. Each patient is unique and may have different preferences, values, and circumstances that should be taken into account when making treatment decisions. By incorporating patient preferences, EBM becomes more personalized and tailored to the individual patient.

Third, incorporating patient preferences can improve the quality and relevance of the evidence. Patient-reported outcomes and experiences can provide valuable insights into the effectiveness and acceptability of different treatments and interventions. By including patient perspectives, the evidence base becomes more comprehensive and relevant.

In conclusion, incorporating patient and family preferences into evidence-based medicine is a complex and challenging task. However, it is crucial for ensuring patient-centered care, promoting individualized treatment decisions, and improving the relevance and quality of the evidence. Efforts should be made to overcome the barriers and challenges to incorporating patient preferences, including providing training and support for healthcare providers in communication and shared decision-making skills. Ultimately, a collaborative approach that integrates the best available evidence with patient preferences and values is essential for optimizing healthcare outcomes.