The role of patients meta‐preferences in the design and evaluation of decision support systems

摘要

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.