Who should judge treatment effects as unimportant?

individual patient encounters

The concept of the smallest worthwhile effect, often used to evaluate treatment effectiveness, may not be as straightforward as previously thought, according to an editorial by Shaheed and others. Dismissing treatments solely based on their failure to meet a standard benchmark can be overly simplistic and may disregard important factors that influence patient outcomes. It is crucial to consider individual patient encounters. This includes baseline health, cost, risk of harms, accessibility, and patient preferences when determining the smallest worthwhile effect.

Varying Estimates and Inconsistent Benchmarks

One of the major challenges with the smallest worthwhile effect is the wide range of estimates that different studies and contexts show. This inconsistency raises concerns about the reliability and applicability of a generic benchmark. Applying the same benchmark to treatments with different costs, access, complexity, and potential for harm becomes illogical and fails to consider the unique characteristics of each intervention.

Involving Patients 

Patients should play an active role in treatment decisions. It is essential to communicate the magnitude, precision, and certainty of treatment effects, enabling patients to make informed choices. Focusing not only on mean between-group differences but also on patient satisfaction and the proportion of patients achieving desired outcomes provides a more comprehensive perspective on treatment efficacy.

Clear Information 

Researchers should provide transparent information about treatment outcomes, risks, alternatives, and contextual factors. This includes conveying details about treatment costs, complexity, ease of access, and safety. Such information empowers patients to understand the broader clinical context and make decisions aligned with their individual circumstances and preferences.

A Nuanced Approach

A more nuanced approach is recommended, categorizing effect estimates as small, moderate, or large. By avoiding the imposition of (arbitrary) cutoffs for the smallest worthwhile effect, patients get the autonomy to assess the clinical utility of treatments based on their personal values and priorities. This approach acknowledges that what may be considered worthwhile can vary among individuals.

 

 

Facilitating Shared Decision-Making

Shared decision-making should be the foundation of treatment discussions. It’s important to consider patient circumstances and preferences, so that decisions are not governed by arbitrary cutoffs for the smallest worthwhile effect. By providing comprehensive information and fostering collaborative decision-making, clinicians and patients can navigate treatment choices together. This can result in more patient-centered care.

Conclusion

As the understanding of the smallest worthwhile effect evolves, it is essential to prioritize patient-centered care. Acknowledging the complexity of treatment decisions and involving patients in the process allows for personalized approaches. Researchers should provide transparent information, categorize effect estimates, and consider contextual factors. 

By embracing shared decision-making and discarding arbitrary cutoffs, we can empower patients to make informed choices that align with their unique circumstances and preferences. Ultimately, prioritizing patients’ needs will lead to more effective and meaningful healthcare outcomes.

Our models, such as the LxH Dynamic Disc Model, help professionals facilitate patient-centered care and clear information. 

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