Preference-Sensitive Apomediative Decision Support Is Key to Facilitating Self-Produced Health.

Abstract

In the health capital model, the main function of health services is not to produce health, but to support the person in their self-production investments. In the health context there are three types of decision support tools, depending on the role of the provider (e.g. clinician) and person. Non-mediative tools are designed to help the clinician decide what is best for the patient. Intermediative Patient Decision Aids are designed to help the clinician and patient decide together, in an encounter, what is best for the patient. Apomediative Personalised Decision Support Tools are designed to help the person decide what is best for themselves, including whether to seek a professional consultation and/or to prepare for, and engage in, an intermediative consultation. Only preference-sensitive apomediative support tools ensure that the key requirements of self-produced health are met, along with legally informed and preference-based consent to any subsequent provider action. The desirable form of apomediative support is a publicly accessible, direct-to-citizen, provider-independent, multi-criteria analysis-based decision support of the sort available in many other areas of self-production. Which (UK), Tænk (Denmark), Choice (Australia) and numerous other comparison magazines and websites provide independent multi-criterial support for decisions on, for example, which food and transport to buy to self-produce nutrition and movement. A personalised decision support tool for the statin decision is provided as illustration: Should I go to my general practitioner and ask for a statin prescription or go to discuss taking statins, in the light of the preliminary opinion of the tool?