Understanding how Social Determinants of Health are integrated within Clinical Decision Science

The editors reflect on the effect of Social Determinants of Health in Clinical Decision Science on questions of efficacy and effectiveness

Guidelines are not evidence

Guidelines are inherently flawed when caring for an individual patient, because they apply to populations, not individuals. A strong competency in reading and interpreting clinical research gives doctors the power to evaluate guidelines and make appropriate shared decisions with their patients

Mechanical thrombectomy for intermediate risk pulmonary embolism

An informed consent article using a set of publications to develop an informed consent conversation for a patient with an acute pulmonary embolism being considered for pulmonary artery thrombolysis

Clinical Decision Science: Proof of concept

Clinical decision science, a newly identified area of scholarship, describes how clinical research is used for a patient, within the context of their unique social conditions. We hypothesize that physicians use sociocultural context as an important input to their decision making. We performed a prospective, randomized, double-blind mixed methods study. Family medicine faculty and residents at a community hospital family medicine residency were included in the study. After academic journal club discussing a primary research paper, physicians were asked if they would prescribe medication for a patient who was similar to the subjects in a research paper. However, social and cultural context was given to the cases. The physicians were block randomized into two groups; Group A was given a case with a patient who had a social and cultural context more conducive to lifestyle modification, while group B had a case more conducive to prescribing medication. Primary outcome was whether or not physicians prescribed medication, allowing for a 2x2 table for analysis. We also asked a free response question regarding the reasoning for their decision and performed qualitative analysis. In group A (n=14), no subjects prescribed medication. In group B (n=18), six subjects prescribed medication. (chi-square statistic with Yates correction 9.95, p=0.001). Thematic analysis in group A showed 22 statements related to medical practice or disease characteristics, and 25 statements related to familial relationships and patient preferences. In group B, subjects who prescribed medication made 30 statements related to medical practice, and 13 statements related to patient preference. Subjects who did not prescribe medication made 10 statements related to medical practice, and 1 statement related to patient preference. This study demonstrates social context of individual patients, together with evidence, affects clinical decision and management. We propose further study into how this affects physician decision making, a scholarly field we call Clinical Decision Science

Clinical Decision Science emphasizes unique social context in a way that Evidence-Based Medicine does not

INTRODUCTION: The ideal of evidence-based medicine includes the integration of clinical experience and patient values with research evidence. We introduce clinical decision science, a new framework that includes patient social context to demonstrate this integration, which has been absent from evidence-based medicine sources. METHODS: This is an observational study comparing published articles within the domains of clinical decision science and evidence-based medicine. In a standardized manner, investigators identified and counted instances of social interaction within the publications. RESULTS: Publications of Clinical Decision Science had a higher number of markers of social interaction per paper and greater proportion of papers that included any markers of social interaction compared to publications in the Evidence-based medicine domain. DISCUSSION: We identified a framework that allows exploration of a new scientific domain that includes both research evidence and individual patient social context