‘What the patient wants’: an investigation of the methods of ascertaining patient values in evidence‐based medicine and values‐based practice

Abstract

Evidence-Based Medicine (EBM), Values-Based Practice (VBP) and Person-Centered Healthcare (PCH) are all concerned with the values in play in the clinical encounter. However, these recent movements are not in agreement about how to discover these relevant values. In some parts of EBM textbooks, the prescribed method for discovering values is through social science research on the average values in a particular population. VBP by contrast always investigates the individually held values of the different stakeholders in the particular clinical encounter, although the account has some other difficulties. I argue that although average values for populations might be very useful in informing questions of resource distribution and policy making, their use cannot replace the individual solicitation of patient (and other stakeholder) values in the clinical encounter. Because of the inconsistency of the EBM stance on values, the incompatibility of some versions of the EBM treatment of values with PCH, and EBM's attempt to transplant research methods from science into the realm of values, I must recommend the use of the VBP account of values discovery.

Understanding What Is Most Important to Individuals with Multiple Chronic Conditions: A Qualitative Study of Patients’ Perspectives

“…18,19 Tools for these decisions, such as decision aids and values clarification methods, are typically closed-ended by design and often do not allow users to revise choices. 33,34 To inform conversations between patients with MCC and providers, we sought a broad understanding of patients' personal values within the home setting. The personal value domains and the findings that values shift and vary in relative importance expand upon the demonstrated need for tools that elicit patients' values comprehensively and iteratively over time.…”

Value as the key concept in the health care system: how it has influenced medical practice and clinical decision-making processes

“…Individual needs, wishes, preferences, and ethics influence the meaning of value which, in turn, is influenced by different cultures or historical periods 1. The necessity of finding better ways of redirecting the incentives away from volume and toward value pushes patients, physicians, policy makers, and other stakeholders to turn their attention toward what value means and what are the main features of this concept 2. Even if there is still no unanimous agreement on value’s definition, it is commonly accepted that values in health care may be defined as normative guidelines helping us to evaluate actions or situations and influencing the decision-making process 3–5…”

“…Consequently, the aim of VBP is to integrate complex and conflicting values in the process of medical decision-making through a skill-based approach where clinicians could make medical decisions on the basis of scientific evidence and social, ethical, and political values 2,29…”

Preferences and influence of the value of health in the contemporary Czech population

“…Health has always been an important human value. Values are often discussed (Busbee et al, 2004;Halligan, 2008;Wieten, 2015) and researched (Mangin et al, 2016) in healthcare and medicine in the context of life quality, health, healthcare and health services. To support the debate, the International Charter for Human Values in Healthcare has been established (Rider et al, 2014), and the discussion often concerns the shift from an evidence-based to values-based approach (Brown et al, 2003;Brown et al, 2005).…”