Decision architecture randomisation: extremely efficient clinical trials that preserve clinician and patient choice?

Introduction Healthcare is full of choices between standard-of-care approaches where one might be better but we do not know which. Examples include ‘at what threshold should magnesium be supplemented for critically ill patients?’ and ‘which insulin formulation should be started in a hospitalised patient with diabetes?’1–3 Observational studies of such questions can be conducted relatively easily but are prone to biases, especially selection bias, that prevent them from reliably showing causal relationships between treatments and outcomes.4 Randomised controlled trials (RCTs) allow stronger causal inference but are major undertakings, typically costing over US$10 000 per patient.5 Beyond financial cost, traditional RCTs disrupt care, especially by assigning treatment based on random chance rather than clinicians’ and patients’ preference. Even for patients who merely consider trial participation, weighing benefits and risks and making a decision may create substantial burdens and stress.
Source: Evidence-Based Medicine - Category: Internal Medicine Authors: Tags: Analysis Source Type: research