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Can contraindications compromise evidence-based, patient-centered clinical practice?
Victor M Montori1, Teresa W Leung, P J Devereaux
1Knowledge and Encounter Research Unit, Department of Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA. montori.victor@mayo.edu
Summary
The "contraindication" label often overrides patient preferences and evidence, influencing clinician treatment decisions. This may hinder patient-centered and evidence-based medical practice.
Area of Science:
- Clinical decision-making
- Medical ethics
Background:
- Contraindications, despite weak evidence, signal adverse risk-benefit profiles.
- Patients may still prefer contraindicated treatments over alternatives.
- The influence of contraindications on treatment choices is not well understood.
Purpose of the Study:
- To quantify the impact of the "contraindication" label on clinical treatment decisions.
Main Methods:
- An international survey of clinicians (American Diabetes Association, College of Physicians and Surgeons of Ontario) was conducted.
- Participants reviewed patient scenarios where a medication had a "contraindication" label but the patient preferred it.
- The study assessed how often the contraindication label overrode patient preference and weak evidence of harm.
Main Results:
- A total of 466 clinicians responded (22% response rate).
- Between 47% and 89% of clinicians reported that contraindications dominated their treatment decisions.
- Contraindications frequently superseded both patient preferences and available research evidence.
Conclusions:
- The "contraindication" label may frequently dominate clinical judgment, potentially compromising evidence-based and patient-centered care.
- Further investigation is needed into the formation of contraindications and their effect on treatment choices.