Transcript Document 7178057

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
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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/patients
Addresses treatment of a defined
condition
Addresses risks and benefits
Uses 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
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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
Canada
Osteoporosis 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
Benefits
Alternatives and Harms
Assist
Information Strength
Decision- Presentation of
making
Evidence
Implicit
Discusses
various
treatments,
but no
direct
comparison
of
alternatives
Yes,
Explore
with
doctor
and find
best
drug for
person
Yes, both
discussed,
but not in
detail
Narrative,
Not
Q&A format, discussed
Table of
bisphosphonates
New Zealand
The New Zealand Guidelines Group
HRT—New Information for Women
http://www.nzgg.org.nz/
guidelines/0078/HRT_su
mmary_web.pdf
http://www.nzgg.org.nz/index.cfm?fuseaction=download&fusesubaction=te
mplate&libraryID=219
NZGG:
HRT—New Information for Women
Appropriate
Audience
Compare
Benefits
Alternatives and
Harms
Assist
Decisionmaking
Information Strength
Presentation of
Evidence
Implicit
Yes;
Yes;
Hot flushes including
(botanicals) WHI
results
table
Vaginal
Clear key
messages
without
specific
guidance
on how to
use
Web (pdf)
and
Pamphlet.
dryness
(lubricants
& topical
E2)
Narrative,
Q&A, Table
on WHI
results.
No direct
statement
(extensive
info on
WHI)
Australia
Australian 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
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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
Benefits
Alternatives and
Harms
Assist
Decisionmaking
Information Strength of
Presentation Evidence
Implicit
Yes
Clear
steps to
follow,
but no
help in
weighing
alternatives
Narrative,
Q&A format
Benefits
in
general,
harms
only in
context
on not
being
effective
for pain
Discusses
which
alternatives
have
research to
support
effectiveness, 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
Benefits
Alternatives and
Harms
Assist
Decisionmaking
Information Strength
Presentation of
Evidence
Yes
Only
among
statins
No,
except for
advice to
talk to
doctor
Web (pdf)
and flyer
Brief info
on
benefits
only, no
info on
specific
harms
Narrative
Text
No, only
that
advice
based on
goodquality
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
Benefits
Alternatives and
Harms
Assist
Decisionmaking
Information Strength
Presentation of
Evidence
Yes
Yes,
OTC meds,
NSAIDs,
COX-2s,
Topicals,
Supplements
Yes, sort
out
benefit,
risk, cost
of choices
Narrative,
Q&A,
Price
comparison
chart
Yes, pain
relief and
risk of CV
event or
GI
bleeding
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?