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Using decision analysis to integrate evidence into decision making
  1. Dawn Dowding, RN, PhD,
  2. Carl Thompson, RN, PhD
  1. Department of Health Sciences and Hull York Medical School; University of York; York, UK

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    One of the challenges of evidence-based nursing is incorporating evidence from research and patient preferences for decision options into our decision making. In this Notebook, we show how using the approach of decision analysis can help nurses make evidence-based decisions.

    What is decision analysis?

    Decision analysis originates from a view of how decisions should be made if a decision maker is logical and rational. This process is called Subjective Expected Utility Theory. From its normative perspective, Subjective Expected Utility Theory stipulates that individuals should “maximise” their expected utility by choosing the decision option that has the highest probability of leading to an outcome that most corresponds with their personal values or beliefs.1

    In decision analysis, the decision problem is structured using a decision tree, in which the probability and utility (value) associated with each outcome is determined, and the “best” decision for the individual is calculated. By deriving probabilities from high-quality research evidence and eliciting patient utilities for decision outcomes, decision analysis can lead to evidence-based decisions.2

    Decision analysis: an example

    The easiest way of illustrating how decision analysis can help nurses make evidence-based decisions in practice is to provide an example.

    You are a nurse working in a community healthcare clinic. You are visited by a 28-year-old man who has smoked since he was 15. His partner recently found out that she is pregnant, and he wants to stop smoking before the baby is born. He has had 2 unsuccessful attempts at stopping smoking using nicotine replacement therapy, and he asks if there are any other ways that he could try. In your practice, several different services are available. These include a telephone-based support service and a group-based counselling service run by yourself and another nurse in the clinic (nurse-led advice). Your patient wants to know the chances of him being successful if he …

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