An economic perspective on evidence-based patient choice in surgery.
The aim of the present paper is to provide an economic perspective on current and emerging issues relating to surgical decision-making. The central issue discussed in the paper is choice and how this relates to patient management. The paper explores three factors that may influence the nature of choice; they are--evidence-based medicine, patient involvement in making choices and the role of cost-effectiveness analysis in surgery. Together, these factors are driving a shift from the traditional model of care based on medical beneficence to one based more on individual patient autonomy. This shift has been described as a move towards 'evidence-based patient choice' (EBPC). The concept of EBPC is relatively new and ill defined. Yet it encapsulates what is happening now and what will occur more dramatically in the future; that is, the nature of the relationship between surgeon and patient is changing. We hope that this paper will provoke discussion on the concept of EBPC and cost-effectiveness analysis in surgical decision-making.
Salkeld
Glenn
G
Surgical Outcomes Research Centre, School of Public Health, University of Sydney, Sydney, New South Wales, Australia. glenns@health.usyd.edua.au
Solomon
Michael J
MJ
D002755:Choice Behavior; D003362:Cost-Benefit Analysis; D003657:Decision Making; D019317:Evidence-Based Medicine; D013502:General Surgery; D006801:Humans; D010358:Patient Participation; D026684:Personal Autonomy; D010817:Physician-Patient Relations; D019057:Quality-Adjusted Life Years; D013514:Surgical Procedures, Operative / Q000191:economics* / Q000706:statistics & numerical data