Decision making is central to health policy and medical practice. Because health outcomes are probabilistic, most decisions are made under conditions of uncertainty. This review considers two classes of decisions in health care: decisions made by providers on behalf of patients, and shared decisions between patients and providers. Considerable evidence suggests wide regional variation exists in services received by patients. Evidence-based guidelines that incorporate quality of life and patient preferences may help address this problem. Systematic cost-effectiveness analysis can be used to improve resource allocation decisions. Shared medical decision making seeks to engage patients and providers in a collaborative process to choose clinical options that reflect patient preferences. Although some evidence indicates patients want an active role in making decisions, other evidence suggests that some patients prefer a passive role. Decision aids hold promise for improving individual decisions, but there are still few systematic evaluations of these aids. Several directions for future research are offered.

中文翻译：

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医学和卫生保健方面的决策。

决策对于健康政策和医疗实践至关重要。因为健康结果是概率性的，所以大多数决定都是在不确定的条件下做出的。这篇综述考虑了医疗保健中的两类决策：提供者代表患者做出的决定以及患者与提供者之间的共同决策。大量证据表明，患者接受的服务存在广泛的地区差异。结合生活质量和患者偏好的循证指南可能有助于解决此问题。系统的成本效益分析可用于改善资源分配决策。共同的医疗决策旨在使患者和提供者参与协作过程，以选择反映患者偏好的临床选择。尽管一些证据表明患者希望在决策中起积极作用，但其他证据表明一些患者更喜欢被动作用。决策辅助工具有望改善个人决策，但是对这些辅助工具的系统评价仍然很少。提供了一些未来研究的方向。