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      The importance of values in evidence-based medicine

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          Abstract

          Background

          Evidence-based medicine (EBM) has always required integration of patient values with ‘best’ clinical evidence. It is widely recognized that scientific practices and discoveries, including those of EBM, are value-laden. But to date, the science of EBM has focused primarily on methods for reducing bias in the evidence, while the role of values in the different aspects of the EBM process has been almost completely ignored.

          Discussion

          In this paper, we address this gap by demonstrating how a consideration of values can enhance every aspect of EBM, including: prioritizing which tests and treatments to investigate, selecting research designs and methods, assessing effectiveness and efficiency, supporting patient choice and taking account of the limited time and resources available to busy clinicians. Since values are integral to the practice of EBM, it follows that the highest standards of EBM require values to be made explicit, systematically explored, and integrated into decision making.

          Summary

          Through ‘values based’ approaches, EBM’s connection to the humanitarian principles upon which it was founded will be strengthened.

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          Most cited references 61

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          Reflective and impulsive determinants of social behavior.

          This article describes a 2-systems model that explains social behavior as a joint function of reflective and impulsive processes. In particular, it is assumed that social behavior is controlled by 2 interacting systems that follow different operating principles. The reflective system generates behavioral decisions that are based on knowledge about facts and values, whereas the impulsive system elicits behavior through associative links and motivational orientations. The proposed model describes how the 2 systems interact at various stages of processing, and how their outputs may determine behavior in a synergistic or antagonistic fashion. It extends previous models by integrating motivational components that allow more precise predictions of behavior. The implications of this reflective-impulsive model are applied to various phenomena from social psychology and beyond. Extending previous dual-process accounts, this model is not limited to specific domains of mental functioning and attempts to integrate cognitive, motivational, and behavioral mechanisms.
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            Evidence based medicine: what it is and what it isn't.

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              What is value in health care?

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                Author and article information

                Affiliations
                [ ]Institute of Public Health, University of Cambridge, Forvie Site, Robinson Way, Cambridge, CB2 0SR UK
                [ ]Royal College of General Practitioners, London, UK
                [ ]Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
                Contributors
                mk744@medschl.cam.ac.uk
                iona.heath22@yahoo.co.uk
                jeremy.howick@phc.ox.ac.uk
                trish.greenhalgh@phc.ox.ac.uk
                Journal
                BMC Med Ethics
                BMC Med Ethics
                BMC Medical Ethics
                BioMed Central (London )
                1472-6939
                12 October 2015
                12 October 2015
                2015
                : 16
                63
                10.1186/s12910-015-0063-3
                4603687
                26459219
                © Kelly et al. 2015

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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                Debate
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                © The Author(s) 2015

                Medicine

                evidence-based medicine, values, medical ethics

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