Decision analysis and the evaluation of decision technologies

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Abstract
Two papers published recently in Quality in Health Care—one by Timmermans and colleagues in this issue2 and the other by Robinson and Thomson on behalf of the Decision Analysis in Routine Treatments Study (DARTS) team3 which appeared in the December issue—suggest that moving towards more analytical judgement and decision making will have considerable benefits in the more serious context of medical care, particularly in the growing number of situations where alternative management strategies have significantly different consequences in terms of quantity and quality of life, or different aspects of health related quality of life. It has been—and still is in many places—traditional for the necessary value judgments to be made implicitly by clinicians without any significant attempt to establish the preferences of the individual patient or, indeed, to address the trade offs explicitly themselves without involving the patient. With increased calls for patient empowerment, the issue of whose preferences are to be used in medical decisions, and how, is coming to the forefront and greater analysis is a necessary prerequisite of any attempt to integrate evidence based and preference driven care.4

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