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Consumer/patient decision support in the new millennium: where should our research take us?

There is a growing interest in the area of decision making and the contributions of nurses to the science of decision support for patients. Several factors have contributed to this interest. The rise of consumerism and patient empowerment has shifted the emphasis from the more passive informed consent to informed choice. Health-services research in practice variations and the movement for evidence-based practice have stimulated the dissemination of clinical guidelines not only to practitioners but also to patients, particularly when the best course of treatment is uncertain; when the decision involves making value trade-offs among risks and benefits; or when patients can play a role in reducing inappropriate use of health services. The increase in technology assessments of current interventions using decision analysis has led to increased identification of treatment decisions that are "utility"- or "value"-sensitive - that is, dependent on the importance that patients place on the risks relative to the benefits. Large outcomes studies and overviews have provided stable estimates of benefits and risks among patient subgroups, which permits tailoring of decision aids. There is also considerable interest in the cost-effectiveness of adopting a more selective, patient preference-oriented approach and reserving interventions for those patients who consider the treatment