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Published on: February 16, 2011
First the facts, then the values? Implicit normativity in evidence-based decision aids for shared decision-making
Bert Molewijk1, Anne M Stiggelbout, Wilma Otten
1Department of Medical Decision Making, Leiden University Medical Center, The Netherlands. b.molewijk@hes.unimaas.nl
Zeitschrift Fur Evidenz, Fortbildung Und Qualitat Im Gesundheitswesen
|February 13, 2009
Summary
Evidence-based decision aids are not value-free; their creation and presentation shape shared decision-making. This study reveals how these tools ethically influence patient autonomy and clinical choices.
Area of Science:
- Bioethics
- Health Informatics
- Clinical Decision Support
Background:
- Shared decision-making (SDM) relies on informed patient autonomy.
- Evidence-based decision aids (EBDAs) are designed to support SDM.
- Existing literature assumes information disclosure precedes SDM.
Purpose of the Study:
- To examine the ethical implications of constructing and using EBDAs.
- To analyze how EBDAs influence the moral environment of SDM.
- To challenge the assumption that information disclosure is value-neutral.
Main Methods:
- Integrated empirical ethics study.
- Analysis of scientific information production and presentation in EBDAs.
- Qualitative assessment of EBDAs' impact on SDM.
Main Results:
- EBDAs embed implicit presuppositions and values.
- The design and presentation of EBDAs morally pre-structure the SDM process.
- EBDAs not only support but also ethically transform SDM.
Conclusions:
- EBDAs and evidence-based medicine are not value-free.
- Patient autonomy and SDM are influenced during EBDA development and presentation.
- Ethical considerations are crucial in EBDA design and SDM practice.
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