What do we know about how evidence of harm and benefit is communicated in other countries?

transcript

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

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

Benefits and Harms

Information

Presentation

Strength of

Evidence

Implicit Yes;

Hot flushes (botanicals)

Vaginal dryness (lubricants & topical E2)

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

Benefits and Harms

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

Benefits and Harms

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

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

Benefits and Harms

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,

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?

What do we know about how evidence of harm and benefit is communicated in other countries?

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