Promoting shared health care decision making using the analytic hierarchy process

Recent developments in medical technology and bioethics have led to a shift in the traditional framework of physician–patient responsibility in health care decision making. Patients are increasingly participating in serious health care decisions, resulting in a “shared decision-making model“ that both patients and their doctors agree is a significant improvement over the traditional system in which a doctor served as the primary decision maker. However, patients are finding they need to develop strategies that allow them to understand and evaluate their health care options in a clear manner. T.L. Saaty’s “Analytic Hierarchy Process” (AHP) is a decision methodology that has been successfully applied to a wide variety of situations and has great potential as a methodology for improved shared health care decision making. This paper reports the results of an experimental use of AHP as a tool to facilitate shared decision making for two specific health care populations. Both groups of patients were deciding amongst their options in terms of two important elective health care procedures: estrogen replacement therapy and cosmetic eyelid surgery. After using AHP, the majority of both patients and physicians agreed that this technique improved physician–patient communication, thus greatly assisting shared health care decisions. When considering other criteria in addition to physician–patient communication, including the entire physician–patient relationship, the patients felt that AHP was preferable to the conventional doctor-patient mode of decision making.     

East Meets West: A Meta-Analytic Investigation of Cultural Variations in Idealism and Relativism

Ethics position theory (EPT) maintains that individuals’ personal moral philosophies influence their judgments, actions, and emotions in ethically intense situations. The theory, when describing these moral viewpoints, stresses two dimensions: idealism (concern for benign outcomes) and relativism (skepticism with regards to inviolate moral principles). Variations in idealism and relativism across countries were examined via a meta-analysis of studies that assessed these two aspects of moral thought using the ethics position questionnaire (EPQ; Forsyth, Journal of Personality and Social Psychology 39, 175–184, 1980). This review identified 139 samples drawn from 29 different countries, for a total sample of 30,230 respondents, and concluded that (a) levels of idealism and relativism vary across regions of the world in predictable ways; (b) an exceptionist ethic is more common in Western countries, subjectivism and situationism in Eastern countries, and absolutism and situationism in Middle Eastern countries; and (c) a nation’s ethics position predicted that country’s location on previously documented cultural dimensions, such as individualism and avoidance of uncertainty (Hofstede, Culture’s Consequences: International Differences in Work-Related Values, 1980). Limitations in these methods and concerns about the validity of these cross-cultural conclusions are noted, as are suggestions for further research using the EPQ.