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Evidence-based medicine targets the individual patient, part 2: guides and tools for individual decision-making
1 University Children’s Hospital, Tuebingen, Germany
2 McMaster University, Hamilton, Ontario, Canada
3 University of Western Ontario, London, Ontario, Canada
| The first 150 words of the full text of this article appear below. |
Despite some suggestions to the contrary,1 2 evidence-based decision-making puts the individual patient on centre stage. In part 1 of this commentary,3 we first described the range of issues that clinicians should consider when applying randomised controlled trial (RCT) results to ensure appropriately individualised care (figure). Second, we have shown how clinicians can use results of prognostic studies and RCTs to determine each patient’s risk of the adverse events that treatment is designed to prevent, and thus each patient’s likely absolute benefit.3 In part 2 of this commentary we will describe additional evidence-based medicine (EBM) guides and tools that advance individual decision-making.
1. GUIDES FOR THE INTERPRETATION OF SUBGROUP ANALYSES
Even if the overall relative summary treatment effect reported in a clinical trial suggests benefit, there may be subgroups within the trial population for whom the therapy is more or less effective, ineffective, or even harmful. The concept of heterogeneity of treatment effects reflects patient diversity in risk of
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