Health Affairs, 26, no. 3 (2007): 715 doi: 10.1377/hlthaff.26.3.715 © 2007 by Project HOPE	New Online   Pay Cuts For Medicare Docs   Access To Care Woes   Public Coverage More Efficient   Empowering Consumers

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Individual Level

PROLOGUE

Risk-Benefit Information At The Individual Level

Many women followed that advice successfully, but others didn’t or couldn’t. A survey of 670 health maintenance organization members taking replacement hormones when the WHI news broke revealed one reason why: bad information. Although 93 percent had heard about the WHI findings, only 57 percent considered the information good, whether provided by the mass media, their health plan, or their care providers. A quiz proved the great majority ill informed. Nevertheless, 56 percent tried to stop taking the hormones within about six months of the trial’s end. The American College of Obstetrics and Gynecology estimates that 65 percent of users nationwide stopped in response to the 2002 WHI developments. What’s worrisome is not that they stopped, but that an unknown number did so without enough support to weigh personal benefits against risks.

Fortunately, the chances of a similar incident seem to be shrinking. As Annette O’Connor and colleagues explain here, the quality, availability, and use of decision-making aids have all improved. Shared, mutually informed decision making produces superior decisions when contemplating treatments whose risks could outweigh their benefits. O’Connor proposes policies that could finally bring us to a "tipping point," where individualized, shared decision making is the rule, not the exception, in clinical practice. James Weinstein and colleagues go a step further; they envision shared decision making replacing the traditional informed-consent process for elective surgery. Next, William Shrank and Jerry Avorn remind us that individual decision-making aids, although improved, remain far from ideal. Consumer drug literature is fragmented, confusing, and inconsistent; moreover, consumers don’t always receive it. Shrank and Avorn propose changes in oversight and standards to ensure integration, cohesion, legibility, and delivery—elements that promote both informed choice and safe use. Finally, Ellen Peters and colleagues reveal why many efforts to communicate risks and benefits numerically engender confusion instead of understanding and how this vital information can be framed to foster productive dialogue and informed decisions.

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