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How do I decide: Evaluating information

Fortunately, many health-related decisions can be made without specifically looking for information. But it is not always easy to decide what to do, particularly when the decisions concern a severe disease or a demanding therapy.

We have listed some questions that can help you in weighing and evaluating information you have collected to arrive at the decision that is best for you individually.

Karl and Peter: The same diagnosis, but very different situations

This is an example of how to sort information you have collected on a specific condition so that you can then weigh and evaluate it.

In the example we are looking at, Peter and Karl have been told by their doctors that they have hypertension (high blood pressure). And they have both been given a prescription for hypertension medication.

Karl is 50. He is healthy, 1.75 meters tall, and weighs 80 kilograms (about 5 foot 9 and about 176 pounds). But his blood pressure is a bit too high at 145 over 92 mmHg.

Peter is also 50. He is the same height as Karl, but weighs 10 kilograms (around 22 pounds) more. His blood pressure is 160 over 100 mmHg. And he smokes.

Neither of them really likes the idea of having to take tablets every day from now on. This is the decision they have to make: Should I take the medication to treat hypertension or should I not take it?

Question 1: What will happen if I just do nothing, and wait and see?

Here the information that has been collected on the course of the disease is important. The course of the disease involves the consequences associated with a particular disease or diagnosis. Doctors call this prognosis. To have an idea of what consequences a disease can have and how frequent they are, information taken from good-quality trials is needed.

Karl and Peter

Hypertension is a risk factor for cardiovascular diseases like stroke or heart attack. The risk of having a heart attack can be estimated:

Over the next 10 years Karl has a 4% risk of having a heart attack if his blood pressure stays the same. That means that out of every 100 men like Karl, 4 will have a heart attack. Or, in other words: 96 out of every 100 men whose health is similar to Karl's will not have a heart attack if they just wait and see.

The risk for Peter of having a heart attack in the next 10 years is 23% because his blood pressure is much higher and he has extra risk factors. Out of every 100 men like Peter, 23 will have a heart attack and 77 will not, assuming they continue to smoke and do not make any other changes affecting their individual risks.

Knowing what your own prognosis looks like might then be enough to base a decision on: either you do not want further treatment because the condition does not worry you much – or you want to do something.

Then it is important to get an overview of the different options for changing the prognosis.

Question 2: What options do I have to do something about it?

This question focuses on the different courses of action you may take. What further examinations might be done and what are the treatment options?

For hypertension there are quite a lot of options ranging from changes in lifestyle and habits to a number of different medications. You can find information about some of these options in our information on hypertension.

Question 3: What are the advantages and disadvantages of the treatment options?

This question concerns a treatment's benefit and harm as well as what will change if I do something as opposed to just waiting and seeing:

What effect can I expect?
When will this effect occur?
How long will the effect last?
How many people have a benefit from this treatment?
What adverse effects might there be?
How many people are harmed by this treatment?
How much is involved in this treatment: expenses, time, hospital stays, having to do without other things?

Karl and Peter

The comparison that follows makes clear how the same treatment has a far greater benefit for Peter than it does for Karl. This is the situation using the example of hypertension medication. The advantages: certain drugs can lower the risk of cardiovascular disease.

The disadvantages: taking the medication comes at a cost: you have to remember to take it every day, you have to go to the doctor regularly, and there might be additional payments when you purchase the medication. Depending on the type of medication, there is risk of adverse effects such as coughing, headache or water retention.

To weigh the advantages and disadvantages it is also necessary to have information on frequency. The table below gives an example of this for treatment using hypertension medication from the diuretics group. Treatment can lower the risk of cardiovascular disease by about 30%. But this has a very different implication for Karl than it does for Peter. Because their risks are different, the possible benefit from treatment ends up being quite different: Out of every 100 men like Karl who take the medication, 1 will be saved from having a heart attack over the next 10 years. But out of 100 men like Peter, 7 will be saved from heart attack. Again, we do not know who these men will be.

Karl's risk of having a heart attack in the next 10 years
	Without medication	With medication (- 30%)	Difference
Risk of a heart attack	4 out of 100	3 out of 100	1 out of 100
Risk of stopping treatment due to adverse effects	–	7 out of 100	7 out of 100

Peter's risk of having a heart attack in the next 10 years
	Without medication	With medication (- 30%)	Difference
Risk of a heart attack	23 out of 100	16 out of 100	7 out of 100
Risk of stopping treatment due to adverse effects	–	7 out of 100	7 out of 100

Question 4: How do I weigh the pros and cons of the different treatments for my individual situation?

From this point on, if not before, the answers can vary from person to person. Scientific research is not able to provide an answer to this question. What your concerns are is a very individual matter. How you evaluate disadvantages and side effects will depend on your individual judgment.

Usually, you must be able to accept side effects of a treatment if you want to have a benefit from its effect. But side effects will typically affect only some people while others will not experience them. If you start to experience very unpleasant side effects, you can usually get them to stop by ending treatment. Side effects that have lasting harm are rare.

Karl and Peter

We will be leaving you in the dark about how each of them decides. It might be that one of them gets more information about other options because for him the chance of having a benefit is not enough to take medication for the long term. And because he would prefer to try out another treatment. The other could have professional or family obligations that make taking medication the best choice at first, and he will consider other treatments later.

To find out why we are refraining from giving a concrete recommendation about the right thing to do in this example read on here.

Question 5: Do I feel informed enough to make a decision?

It might be that the information you have collected and gone through is still not enough to base a decision on. Maybe there is something else important to you that you cannot yet evaluate. Then you still have the chance to go back and start a more specific search for missing information.

Or you can go talk to your doctor again. You can also consult another doctor to feel more sure about it. Self-help groups and counseling centers are another possibility.

It is also important not to put yourself under too much pressure, or let others put you under too much pressure. Especially if a chronic disease, screening or preventative care is involved, it is often possible to take your time. It is also possible to make a tentative decision you can reconsider whenever you want.

Further information:

Here we describe how you can collect information as a first step:

How do I decide: Collecting information

Additionally, we describe how we take these topics into account at Informed Health Online:

How do I decide: How can Informed Health Online help?

One additional aid that you can either download as a PDF or print out:

Decision aid for treatment options (in German)

A decision aid is a special kind of patient information. It can help you weigh the facts and your personal attitudes and values against one another.

Author: Institute for Quality and Efficiency in Health Care (IQWiG)