[How should patients' utilities be incorporated into clinical decisions? 2008 SESPAS Report]

There are many clinical situations in which there is no "right" decision from a technical point of view. An example of this is elective surgery, in which patients' preferences are critical. One way to integrate patients' preferences within clinical practice is the application of decision analysis. According to this approach, preferences (utilities) are assessed and are then combined with physicians' knowledge. This combination of evidence and utilities leads to the so-called shared decision-making (SDM) model. The overview provided in the present article indicates that: a) The SDM model, if systematically applied, could improve treatment effectiveness and patients well being; b) clinical practice, nevertheless, faces barriers in the form of time and resource constraints, limiting the application of such a model; c) discrepancies between patients' and doctors' preferences could be narrowed if patients' utilities were included in clinical practice guidelines; d) the application of this kind of analysis seems to be scarce in Spain. Moreover, information provided to patients is probably insufficient; and e) patient decision aids, even though their use is rapidly growing, are subject to certain problems.