CER Essay Introduction

Abstract

Decisions imply choices between options, leading to a need for comparative information. Those decisions interesting enough to research tend not to be straightforward. This situation occurs frequently when the idiosyncrasies of the human body meet the creativity of medical science and the many new technologies developed annually. Patients often find their medical choices daunting and experience frustration when information is insufficient or not tailored to their particular situation. The United States has committed to comparative effectiveness research (CER) investments that are expected to pay off in terms of increasing the knowledge base about relevant choices, including 100 real health care dilemmas recently prioritized by the Institute of Medicine (available at www.iom.edu/ cerpriorities). The paradigm, as well as the product, of comparative research puts decision makers in the driver seat, with an information highway worth the journey. Patients, clinicians, health care organizations, technology inventors, governments, and insurers can travel on the same highway and make much more informed decisions based on their respective preferences and needs. As a research and education community, the Society for Medical Decision Making’s decision choices tend toward the methodological—is one research technique more robust than another for a specific CER question? But our community is also interested in thinking about how to increase the likelihood of realizing the potential benefits of CER. These essays tackle both of these themes in an accessible manner. We hope that the set together fascinates you as much as it did us, as research practitioners of CER. All of us are also patients at one point or another. We hope you wear your patient hat in any discussion of CER and anticipate that these essays will enlighten those conversations. Adrian Levy, Brian Harrigan, Karissa Johnston, and Andrew Briggs ask the following: will CER meet the objectives purported of improving health care decision making, changing clinical practice, promoting increased value, and reducing disparities? David Howard explores cancer screening decision making in Europe and the United States to consider similar questions.