Individualized Medical Decision Making

Abstract

There is an urgent need to provide older persons with individualized information regarding the benefits and harms of different diagnostic and treatment strategies. This need results from the growing recognition of the heterogeneity in outcomes among older persons with differing comorbidity profiles. The importance of heterogeneity in outcomes has been most thoroughly described in cancer screening. The heterogeneity of benefits and harms resulting from treatment is not yet as well appreciated. Warfarin versus aspirin for the reduction of stroke risk in nonvalvular atrial fibrillation (NVAF) provides an example of a treatment for which the benefit to harm ratio may actually reverse according to an older person’s comorbidities, thus highlighting the importance of basing this treatment decision on individualized outcome data Despite the wealth of studies in NVAF, many assumptions are necessary to calculate patient-specific outcomes, and these assumptions may lead to substantial over- or under-estimation of benefits and harms. Improving care for patients with co-morbidities will require substantive increases in the efforts and resources allocated towards the collection and dissemination of outcome data for patients with varying comorbidities.