What do we know about how evidence of harm and benefit is communicated in other countries?
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What do we know about how evidence of harm and benefit is communicated in other countries? Valerie King MD, MPH and David Hickam MD, MPH John M. Eisenberg Clinical Decisions and Communications Science Center Oregon Health & Science University
description
What do we know about how evidence of harm and benefit is communicated in other countries?. Valerie King MD, MPH and David Hickam MD, MPH John M. Eisenberg Clinical Decisions and Communications Science Center Oregon Health & Science University. Overview. Set the Stage—International Context - PowerPoint PPT Presentation
Transcript of What do we know about how evidence of harm and benefit is communicated in other countries?
What do we know about how evidence of harm and benefit is communicated in
other countries?
Valerie King MD, MPH and David Hickam MD, MPH
John M. Eisenberg Clinical Decisions and Communications Science Center
Oregon Health & Science University
Overview
Set the Stage—International Context Literature Review Describe International Examples Overall Goals for Today:
– Identify Best Practices– Identify Gaps in Research– Apply Discussion to Eisenberg Center’s Work
Methods
Literature Review– Medline--1996-2006 – Search Terms:
• Patient Education• Evidence-based Medicine• Pharmaceutical Preparations
Consumer Information Products from Other Countries– Description– Compare characteristics
Literature Review
Criteria for inclusion:
Describes an information tool for use by consumers/patientsAddresses treatment of a defined conditionAddresses risks and benefitsUses evidence
Results of Literature Review
Search retrieved 544 citations 18 citations met inclusion criteria
and were reviewed in full 5 citations excluded for accessibility
– 3 non-English– 2 inaccessible journal
13 final articles included in review– 2 systematic reviews– 11 original studies
Description of Evidence Translation Approaches in the Medical Literature
Many examples of descriptive reports of tools used for single diseases, without evaluation
Many programs deal with health promotion or high stakes treatments (oncology topics)
Evolution from booklets to internet sites Health literacy is a frequent theme Evaluations focus on understandability and
motivation to talk to provider Sample sizes generally small
Example from Medical Literature (United States)
Decision: prostate cancer treatment Multiple formats: booklet, web-based,
audiotape Explicit approach to translation of
evidence (but not rating of strength) Explicit description of harms of treatments Booklet not available for review
Holmes-Rovner M et al. Evidence-based patient choice: a prostate cancer decision aid in plain language. BMC Medical Informatics and Decision Making 2005; 5(1):16.
Example from Medical Literature (Northern Ireland)
Decision: hormonal therapy for prostate cancer
Format: booklet (not available for review) Approach to translating evidence not
described Included description of harms of treatments Evaluated knowledge and satisfaction
Templeton H, Coates V. Evaluation of an evidence-based education package for men with prostate cancer on hormonal manipulation therapy. Patient Education and Counseling 2004; 55:55-61.
Information Products from Other Countries
How is risk and benefit communicated to health care
consumers?
Criteria for selection of consumer information products for description
Topic related to a pharmaceutical agent Product available in print or web-based format Related to an evidence review with or without an
associated clinical practice guideline Government involvement in review and/or product English speaking country with advanced
healthcare system• Canada• Australia• New Zealand• United Kingdom
Framework for Description of Consumer Information Products
Does product describe the audience to whom it applies?
Does it discuss alternative treatment options? Does product discuss harm and benefit of
treatment with the drug? Does it give guidance on how the information
can be used in decision-making? How is information presented? How does product discuss strength of
evidence about benefits and/or harms?
Canada and New Zealand
Canada– Clinical Practice Guidelines for Diagnosis and
Management of Osteoporosis in Canada (2002)– Osteoporosis Canada Website, “Drug Treatments”
New Zealand– New Zealand Guidelines Group—Hormone
Replacement Therapy (2004)– HRT—New Information for Women
Australia and United Kingdom Australia
– Australian Acute Musculoskeletal Pain Guidelines Group—Evidence-based Management of Acute Musculoskeletal Pain (2003)
– Acute Low Back Pain
United Kingdom– National Institute for Health and Clinical Excellence
(NICE)—Statins for the prevention of cardiovascular events (2006)
– Statins for the prevention of cardiovascular events. Understanding NICE guidance—information for people who have or are at increased risk of cardiovascular disease, their families and the public
CanadaOsteoporosis Canada
“Drug Treatments” (website)
Brown, et al. CMAJ 2002.
Osteoporosis Society of Canada. Osteoporosis Update 2003.
www.osteoporosis.ca
Osteoporosis Canada: About Osteoporosis--Drug Treatments
Appropriate Audience
Compare Alternatives
Benefits and Harms
Assist Decision-making
Information
Presentation
Strength of
Evidence
Implicit Discusses various treatments, but no direct
comparison of alternatives
Yes, both discussed, but not in detail
Yes,
Explore with doctor and find best drug for person
Narrative,
Q&A format, Table of bisphos-phonates
Not discussed
New Zealand
The New Zealand Guidelines Group
HRT—New Information for Women
http://www.nzgg.org.nz/guidelines/0078/HRT_summary_web.pdf
http://www.nzgg.org.nz/index.cfm?fuseaction=download&fusesubaction=template&libraryID=219
NZGG: HRT—New Information for Women
Appropriate Audience
Compare Alternatives
Benefits and Harms
Assist Decision-making
Information
Presentation
Strength of
Evidence
Implicit Yes;
Hot flushes (botanicals)
Vaginal dryness (lubricants & topical E2)
Yes;
includingWHI results table
Clear key messages
without specific guidance on how to use
Web (pdf) and Pamphlet.
Narrative, Q&A, Table on WHI results.
No direct statement
(extensive info on WHI)
AustraliaAustralian Acute Musculoskeletal
Pain Guidelines Group
Acute Low Back Pain
http://www.nhmrc.gov.au/publications/synopses/cp94syn.htm
Associated Patient Materials on Acute Musculoskeletal Pain
Low Back Pain Thoracic Spinal Pain Neck Pain Shoulder Pain Anterior Knee Pain
Complete clinician guide also available
Australian Acute Musculoskeletal Pain Guidelines Group:Acute Low Back Pain
Appropriate Audience
Compare Alternatives
Benefits and Harms
Assist Decision-making
Information
Presentation
Strength of
Evidence
Implicit Yes Benefits in general, harms only in context on not being effective for pain
Clear steps to follow, but no help in weighing alterna-tives
Narrative, Q&A format
Discusses which alternatives have research to support effective-ness, but not strength of evidence
United Kingdom
Statins for the Prevention of Cardiovascular Events
http://www.nhmrc.gov.au/publications/synopses/cp94syn.htm
NICE: Statins for the Prevention of Cardiovascular Events
Appropriate Audience
Compare Alternatives
Benefits and Harms
Assist Decision-making
Information
Presentation
Strength of
Evidence
Yes Only among statins
Brief info on benefits only, no info on specific harms
No, except for advice to talk to doctor
Web (pdf) and flyer
Narrative
Text
No, only that advice based on good-quality studies
AHRQ:Effective Health Care Program
The John M. Eisenberg Center
Example of an Eisenberg Center Product in
Development
Choosing Pain Medicine—
A guide for people with osteoarthritis
Eisenberg Center: Choosing Pain Medicine—
A guide for people with osteoarthritis
Appropriate Audience
Compare Alternatives
Benefits and Harms
Assist Decision-making
Information
Presentation
Strength of
Evidence
Yes Yes,
OTC meds,
NSAIDs, COX-2s,
Topicals, Supple-ments
Yes, pain relief and risk of CV event or GI bleeding
Yes, sort out benefit, risk, cost of choices
Narrative,
Q&A,
Price comparisonchart
Not discussed directly
An International Perspective Information for consumers contains background
info, going beyond the systematic evidence review Other countries develop clinical practice guidelines
for use in health service—different context UK has very explicit link between evidence review
and consumer products Detailed harm and benefit information rare Decision-making referred to doctor consultation None provide explicit strength of evidence
What can we learn?
Are there best practices employed in other countries that can help guide how the Eisenberg Center develops information products?
How can the Eisenberg Center best contribute to narrowing the gaps in our knowledge of how best to communicate with health care consumers?
