Communicating About Mortality in Health Decision Support: ‘What and Why and When, and How and Where and Who’
Dowie, Jack;
Kaltoft, Mette Kjer;
Rajput, Vije Kumar;
(2021)
Communicating About Mortality in Health Decision Support: ‘What and Why and When, and How and Where and Who’.
In: UNSPECIFIED, (ed.)
pHealth2021.
Studies in Health Technology and Informatics, 285
.
IOS Press.
DOI: https://doi.org/10.3233/shti210570
Permanent Identifier
Use this Digital Object Identifier when citing or linking to this resource.
The Covid-19 pandemic has only accelerated the need and desire to deal more openly with mortality, because the effect on survival is central to the comprehensive assessment of harms and benefits needed to meet a ‘reasonable patient’ legal standard. Taking the view that this requirement is best met through a multi-criterial decision support tool, we offer our preferred answers to the questions of What should be communicated about mortality in the tool, and How, given preferred answers to Who for, Who by, Why, When, and Where. Summary measures, including unrestricted Life Expectancy and Restricted Mean Survival Time are found to be reductionist and relative, and not as easy to understand and communicate as often asserted. Full lifetime absolute survival curves should be presented, even if they cannot be ‘evidence-based’ beyond trial follow-up limits, along with equivalent measures for other criteria in the (necessarily) multi-criterial decision. A decision support tool should relieve the reasonable person of the resulting calculation burden.