In the last century, there has been tremendous advancements in medicine and surgery and this progress has resulted in an over expansion of the number of treatment options that are available to treat many conditions. The enlarging armamentarium available to modern physicians should be celebrated. However, this has come with a significant increase in the complexity of decisions that physicians have to make when they select a therapy among many that have comparable efficacy. For example, small hepatocellular carcinomas can be treated with liver transplantation, surgical resection or locoregional therapies, with similar overall survival but different disease free survival and morbidities. One of the primary goals of decision analysis is to help decision makers. In healthcare, this translates in more cost-effective treatments, higher patients’ satisfaction and overall better outcomes. Because judgments of uncertainty are a critical part of medical decision-making, decision analysis tends to improve the accuracy of these judgments by using specific algorithms and techniques. The main aim of this review is to make clinicians familiar with the different levels of decision analysis. In this paper, we will describe common techniques that are used to elicit patients’ preferences, the meaning of utilities and the benefit and limitations of decision analysis in health care.

In recent years, the patients’ rights movement has sought to increase involvement of patients in decisions about their care since their active participation improves their outcomes. This might be due to better compliance or to the overall benefits that come when patients are engaged and actively looking for their full recovery. When physicians elicit patients’ preferences for an intervention (medical therapy or surgical procedure), they have an opportunity to explain what are the potential risks and benefits of all the available treatment options. Therefore, in 2007, a new legislation in the United States has officially recognized that shared decisions, between caregivers and patients, is necessary and represents the highest standard of informed consent. However, to reach the ambitious goal of incorporating patients’ views and values using shared decision methods, physicians and other caregivers need to be familiar with decision analysis techniques. The vast majority of practicing clinicians already evaluate patients’ desires and their expectations, but most of the times this is done in an implicit manner because health care decisions are often ethically difficult and time consuming as they need to take into account complex dimensions such as personal beliefs, faith, societal values, cultural, and socioeconomic pressures.

In healthcare, there are many situations where the most desirable decision depends entirely on how patients value the expected outcomes, and the relevant health states they will experience during and after their care is completed. For example, when dealing with patients with malignant diseases, the decision to choose longer survival versus side effects of the treatment should depend largely on what patients value the most. For all these reasons, decision analysis instruments that can be used at the bedside cannot only help patients, but also physicians who face difficult decisions. This review aims at illustrating the different levels and most common instruments used in decisionmaking. Since the discipline of decision-analysis is not mandatory during the formation of health-care providers, we hope that his review might be of some help to clinicians who are interested in exploring further this discipline.

With Regards,
Sara Giselle
Associate Managing Editor
Global joournal of Digestive Diseases