RT Journal
A1 Keirns CC, Goold S
T1 PAtient-centered care and preference-sensitive decision making
JF JAMA
JO JAMA
YR 2009
FD October 28
VO 302
IS 16
SP 1805
OP 1806
DO 10.1001/jama.2009.1550
UL http://dx.doi.org/10.1001/jama.2009.1550
AB 
In most situations, patients value prevention of disease and disability and increased length of life, so patient-centered care and application of evidence-based medicine present no conflict. Despite general preferences for health over disease, however, individuals make trade-offs every day by working in dangerous or stressful jobs, driving too fast, eating too much, smoking, and taking dozens of other risks, large and small. These everyday compromises are also seen in clinical practice. Patients may choose a less expensive medication even if that medication is not quite as effective. They may choose a more limited operation for cancer, explicitly trading off survival for quality of life. They may decline chemotherapy because they feel the adverse effects are not worth the small chance of success.