Decision analysis and the implementation of evidence-based medicine

The evidence-based medicine movement has received enthusiastic endorsement from editors of major medical journals. Hardly anyone can disagree with the aim of helping clinicians to make judicious use of the best scientific evidence for decisions in patient care. Evidence-based medicine, however, because of its dependence on randomized trials, cannot be applied to all individuals seen in daily practice. Specifically, patients may differ in age, severity of illness, presence of comorbidity and myriad of other clinical nuances. In response to these limitations, decision analysis, a technique which allows to consider multiple health outcomes, such as the patient's preferences for different states of health, and to measure the consequences of many strategies for which randomized trials are not feasible, provides a rational means of allowing health professionals to move from finding evidence to implementing it. Such formal approach may reconcile evidence-based medicine with `real life' and patient's preference. It should therefore be considered complementary to evidence-based medicine.