Furthermore, in countries with fewer resources, the cost per capita of healthcare may limit statin use, and healthcare-related decisions may not that of resource-rich countries. Thus, identified gaps in equity necessitate suitable plans: the decision for higher-risk patients might be high-intensity statin while for lower-risk patients, counselling him/her about positive family history and his/her preferences regarding his/her ability to change and health priorities.
In this situation, in which a patient reflects on his/her values of what he/she sees as a gain or loss and the consideration of acceptability of lifestyle modifications versus commitment to lifelong statin treatment with an emphasis on the long-term benefits, harms and costs are determinants in the bargaining process, adding to the physician’s rationality of determining value. Preferably, the patient will be informed about their options and will contribute to the decision by weighing options with the physician. In the end, the shared best judgement between the physician and patient is selected. However, when identifying any need to change or any new opportunity to improve a patient’s life, this new identified need or opportunity is followed by the development of and search for new possible options, after which re-evaluation occurs and multiple meta-decision cycles may be needed to reach the best decision.
Example (2). Validating decisions for a national genetic screening program will require information on the budget and resources needed along with local data on genetic diseases’ epidemiology, socio-economic status, and health literacy—essential to inform decision consequences. Careful analysis of each decision developed previously is to be validated through bargaining and weighing options against each other. For example, while genetic testing has the long-term benefit of avoiding genetic diseases in children, a short-term outcome may be test anxiety due to results of uncertain significance or any immediate decisions the couple may take to avoid children with possible diseases. Another long-term harm is exposing the couple and their children to explicit genetic data with possible employment or treatment disadvantages. The freedom to make choices might be affected due to the influence of others, such as the government or their community, on decision-making.
The process appraisal and feedback on the success or failure of meta-decisions’ processes contribute to improving future meta-decisions. Research using local data is crucial for making informed validated decisions for special populations in all settings. The approach of meta-decisions will also prevent unstructured decision-making and accommodate differences.
It is worth noting that clinical practice guidelines and protocols provide choices, facts, and ideas that can be used in the meta-decision process and its steps. Therefore, meta-decision is the junction to deliver the right evidence to the right patient. This is true for clinical decision support tools as well, which are increasingly available at the point of decision-making. It was found to reduce costs, improve quality, and reduce medical errors in clinical settings.23 Nevertheless, it provides mainly clinical knowledge, but is not relevant to other domains considered important in medical decision-making as a social determinant of health and patient preferences. 24 However, the question remains of does it facilitate accessibility to data and ideas on expenses of limiting search and design. This needs to be better studied through its use with the meta-decision approach. Table 1 shows the concept applied on more examples.