JAMA : the journal of the American Medical Association
In Reply It appears that we are not in disagreement with Drs Powell and Partin, who state that instead of focusing on bias reduction, a better litmus test of the appropriateness of communication is whether it facilitates informed, value-concordant decisions by patients. Similarly, we stated in our Viewpoint that the aim of our model of persuasion is precisely to help patients make autonomous decisions in line with their basic beliefs; bias reduction is merely the first step in achieving this objective.
Powell and Partin also claim that the appropriateness of bias reduction should be judged according to whether the resulting weights placed on short- and long-term outcomes are consistent with a patient’s underlying values. Once again, we believe the aim of removing bias in such cases is not necessarily to prevent patients from fulfilling their wish to avoid short-term harm but to make sure that they are aware of the potential long-term costs of doing so. If the results of bias reduction were a new bias against a patient’s deeply held beliefs, the attempt at persuasion would indeed have failed.
In addition, Powell and Partin believe the most appropriate recommendations are those that are made with sensitivity to how patients value the potential outcomes of the final decision. This is precisely the objective of our model of persuasion: to provide patients with evidence-based information about the different options available to them while also removing any biases that might distort their interpretation of this evidence, thereby enabling them to make autonomous choices that are in accordance with their core values.