N=1 Causal reasoning and evidence for clinical decisions

January 12, 2016 - January 13, 2016
CauseHealth, Norwegian University of Life Sciences

Norwegian University of Life Sciences
Aas 1430
Norway

Sponsor(s):

  • Trinity

All speakers:

Rani Lill Anjum
Norwegian University of Life Sciences
Alex Broadbent
University of Johannesburg
Raffaella Campaner
University of Bologna (Italy)
Rachel Cooper
Lancaster University
(unaffiliated)
Jonathan Fuller
University of Toronto
Tobias Gustum Lindstad
Oslo
Roger Kerry
Nottingham
Anna Luise Kirkengen
Norwegian University of Science and Technology
Matthew Low
Bournemouth
Robyn MacQuarrie
Dalhousie University
Carlo Martini
University of Helsinki
Andrew Miles
Madrid & London
Stephen Mumford
University of Nottingham
Elena Rocca
Norwegian University of Life Sciences
Henrik Vogt
NTNU

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Confronted with different types of evidence, the practitioner must consider which is the most relevant for their patient. Medical evidence can come from various sources: clinical experience, theoretical training and mechanistic knowledge, population studies and systematic reviews of these, to mention some. Evidence-based policies acknowledge all of these as relevant for clinical decisions, although to various degree. Quantitative studies generally rank higher in the evidence hierarchy than theory and experience, and qualitative studies are often devaluated or disregarded.

In clinical situations, however, the evidence from population studies cannot be directly applied to the individual patient. Even if we try to specify the relevant patient population, the most relevant subgroup is the N of 1; the patient. Many practitioners therefore emphasise the value and importance of patient stories and qualitative research, and we see a growing interest in multidisciplinary networks such as person centered healthcare and medical humanities.

While evidence-based policies recommend that clinical decisions are guided by evidence from population studies, practitioners have argued that causal and contextual information about the individual patient ought to be given epistemic priority over quantitative information about a patient population. This can be supported philosophically, from a perspective of causal singularism and complexity. On this view, causal reasoning and inference should be bottom up: from the local and particular to the global and general, rather than vice versa. Still, in the interest of informing health policies and guidelines, a question remains of whether, how and to what extent we should expect qualitative and largely patient-specific evidence to be generalisable to other patients. 

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December 22, 2015, 12:00pm CET

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