The role of patients' meta-preferences in the design and evaluation of decision support systems.
The arrival of new analysis-based decision technologies will necessitate a profound rethinking both of the nature of the patient-doctor relationship and of the way aids and support systems designed to improve decision-making within that relationship are designed and evaluated. One-dimensional typologies of the traditional 'paternalist/shared/informed' sort do not provide the complexity called for by the heterogeneity of patient's 'meta-preferences' regarding their relationship with a doctor on the one hand and regarding the analytical level of judgement and decision-making on the other. A multidimensional matrix embodying this distinction is proposed as a framework of the minimal complexity required for the design and evaluation of the full range of decision aids and decision modes. Essentially aids should be conceived of and evaluated cell-specifically and the search for universally satisfactory decision support systems abandoned. 'shared' and'informed' are best interpreted as attributes which may or not be in line with a patient's meta-preferences. Future research should focus on the higher level goal of better decision-making, a goal that will need to respect and reflect these meta-preferences.
Dowie
Jack
J
Public Health and Policy Department, London School of Hygiene and Tropical Medicine, UK. jack.dowie@lshtm.ac.uk
D003376:Counseling; D003657:Decision Making; D020000:Decision Support Systems, Clinical / Q000592:standards*; D006801:Humans; D017146:Models, Organizational; D010358:Patient Participation; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D012985:Software Design; D006113:United Kingdom