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Hunink M, Glasziou P, Siegel J, et al. Decision making in health and medicine. Integrating evidence and values. Cambridge: Cambridge University Press, 2001.
  1. Chris Hyde, MBBS, MRCP, MFPHM
  1. University of Birmingham
 Birmingham, UK

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    Aims. This book supersedes the highly respected text Clinical decision analysis by Weinstein et al published in 1980. Its main purpose is to provide insights and tools that can aid decision making in health care. In this, like its predecessor, it eminently succeeds.

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    Decision making in health and medicine. Integrating evidence and values is available from for £38.00.

    Target audience. The flyer makes the bold claim that the user-friendly text will help everyone involved in healthcare and medical decision making, specifically practitioners, trainees, and students studying clinical decision analysis, evidence-based medicine, and clinical epidemiology. Although a little hyperbole is to be expected, this description has serious potential to mislead. Despite being extremely well written and structured, and furnished with a wealth of supporting information on the accompanying CD-ROM, size alone makes the book an inappropriate place to start for those wanting an introduction to decision support techniques. It is appropriate as a text to support attempts to do decision analysis. Some familiarity with the concept of decision analysis is required to make the most of this book.

    Methods/quality of information. There is no information on how the resource was compiled, although this would be unusual for a methodological publication. It is debatable just what such information might have added and whether greater explicitness might be appropriate for any future editions. However, a frustrating omission was how the tools described had changed from those in Weinstein et al’s original text, and what had prompted these changes.

    List of contents. There are 12 chapters.

    • Elements of decision making in health care is an initial overview.

    • Managing uncertainty explores the fundamental rules of probability and the concept of expected utility.

    • Choosing the best treatment explains the use of decision trees to determine the best treatment under conditions of diagnostic uncertainty.

    • Valuing outcomes outlines utility assessment.

    • Three chapters—Interpreting diagnostic information, Deciding when to test, and Multiple test results—deal with sequentially more sophisticated tools concerning decisions relating to tests, starting with Bayes’ theorem.

    • Finding and summarising the evidence discusses tools for identifying the best available data and managing its limitations.

    • Constrained resources introduces the tools of cost effectiveness and cost utility analysis.

    • Recurring events and Variability and uncertainty are 2 chapters introducing modelling techniques, including Markov models and Monte Carlo simulation.

    • Proactive decision making: a way of life concludes the book by revisiting the steps of the approach to clinical decision making represented by the PROACTIVE mnemonic.

    The accompanying CD-ROM contains solutions to exercises (approach to imminent Markov madness in chapter 10 particularly appreciated!), decision analytic software, examples of the decision models, supplementary materials including useful spreadsheets, and the references with abstracts.

    Clinical usefulness. This is not a resource designed to provide clinically useful answers directly. But clinically useful answers would undoubtedly flow from clinicians or policy makers equipped with the skills the book seeks to impart. It is difficult to dip into without a clear overall understanding of the subject, but this might well be gained initially by reading the book in its entirety. In contrast to many textbooks, the readability, good structure, and well chosen illustrative examples make such a cover to cover journey feasible. I will certainly use the resource and will recommend it to masters level students—I do not anticipate much use at the undergraduate level. Given the growing importance of the tools described in this book, the need for an introductory text or article suitable at the undergraduate level is highlighted.

    Conclusion. This is an excellent resource dealing with the conduct of increasingly important and ubiquitous decision aids but is not suitable for those seeking an introduction to them.

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