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4 - Valuing outcomes

Published online by Cambridge University Press:  05 October 2014

M. G. Myriam Hunink ,
Milton C. Weinstein ,
Eve Wittenberg ,
Michael F. Drummond ,
Joseph S. Pliskin ,
John B. Wong  and
Paul P. Glasziou
M. G. Myriam Hunink
Affiliation:
Erasmus Universiteit Rotterdam
Milton C. Weinstein
Affiliation:
Harvard University, Massachusetts
Eve Wittenberg
Affiliation:
Harvard School of Public Health, Massachusetts
Michael F. Drummond
Affiliation:
University of York
Joseph S. Pliskin
Affiliation:
Ben-Gurion University of the Negev, Israel
John B. Wong
Affiliation:
Tufts University, Massachusetts
Paul P. Glasziou
Affiliation:
Bond University, Queensland
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Summary

Values are what we care about. As such, values should be the driving force for our decision making. They should be the basis for the time and effort we spend thinking about decisions. But this is not the way it is. It is not even close to the way it is.

Ralph Keeney

Introduction

Value judgments underlie virtually all clinical decisions. Sometimes the decision rests on a comparison of probability alone, such as the probability of surviving an acute episode of illness. In such cases, there is a single outcome measure – the probability of immediate survival – that can be averaged out to arrive at an optimal decision. In most cases, however, decisions between alternative strategies require not only estimates of the probabilities of the associated outcomes, but also value judgments about how to weigh the benefits versus the harms, and how to incorporate other factors like individual preferences for convenience, timing, who makes decisions, who else is affected by the decision, and the like. Consider the following examples.

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Type
Chapter
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Decision Making in Health and Medicine
Integrating Evidence and Values
 , pp. 78 - 117
Publisher: Cambridge University Press
Print publication year: 2014

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