"Absence of evidence is not evidence of absence"-Rethinking NHS England`s inguinal hernia surgery decision aid.

Abstract

Decision support tools (DSTs) are increasingly used to guide patient choice in surgery, yet the way they present uncertainty is critical to informed consent. While reviewing NHS England's DST for inguinal hernia surgery, I noted the statement "none did" in response to whether patients had experienced allergic or autoimmune reactions to mesh. No supporting clinical evidence could be identified for such a definitive claim, despite manufacturers' Instructions for Use (IFUs) acknowledging the possibility of allergic responses to surgical mesh. The DST adopts more cautious language ("no good data available") when addressing other mesh-related risks, raising questions about consistency and accuracy in patient communication. This case, though UK-specific, highlights a broader challenge for all health systems: how to balance clarity with transparency about the limits of evidence. Ensuring that national decision aids reflect not only consensus but also uncertainty is essential for patient trust and truly informed decision-making.