The Future of Health Is Self-Production and Co-Creation Based on Apomediative Decision Support.

Cultural changes are needed in medicine if the benefits of technological advances are to benefit healthcare users. The Digital Health Manifesto of 'medical futurist' doctor Bertalan Meskó and 'e-patient' Dave deBronkart, The Patient Will See You Now by Eric Topol and The Patient as CEO by Robin Farmanfarmaian, are among the proliferating warnings of the approaching paradigm shift in medicine, resulting, above all, from technological advances that gives users independent access to exponentially increasing amounts of information about themselves. We question their messages only in suggesting they do not sufficiently shift the focus from 'patient' to 'person' and consequently fail to recognise the need for the credible, efficient, ethical and independent decision support that can ensure the 'democratisation of knowledge' is person empowering, not overpowering. Such decision support can ensure the 'democratisation of decision,' leading to higher quality decisions and fully-informed and preference-based consent to health provider actions. The coming paradigm will therefore be characterised by apomediative ('direct-to-consumer') decision support tools, engaged with by the person in the community to help them make health production decisions for themselves (including whether to consult a healthcare professional or provider), as well as intermediative ('direct-from-clinician') tools, delivered by a health professional in a 'shared decision making' or 'co-creation of health' process. This vision paper elaborates on the implementation of these preference-sensitive decision support tools through the technique of Multi-Criteria Decision Analysis.