Decisions aids (DAs) aim to improve patient understanding and decision making about healthcare. Guidelines recommend that DAs regarding screening tests present detailed quantitative information regarding baseline risk with no screening, risk reduction provided by screening, and the probability of negative outcomes such as false positives, false negatives, and overtreatment after screening. This recommendation - the "quantitative imperative" - stems from the assumption that patients need such data to make informed choices. But numbers may also be confusing to patients, especially those with limited numeracy, or may trigger irrational heuristics or biases. I argue that the "quantitative imperative" rests on questionable assumptions about the nature of rationality and the demands of the ethical principle of "respect for autonomy." In this paper, I review the quantitative imperative and questions about it, and assess the prospects for a research program aimed at testing various approaches to providing patients with data using DAs.
Dr. Peter Schwartz (Faculty Investigator at the Indiana University Center for Bioethics, Associate Professor of Medicine in the Division of General Internal Medicine Indiana University School of Medicine, Associate Professor of Philosophy, College of Arts and Sciences, Indiana University)
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