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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

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

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  1. 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

  2. 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

  3. Methods • Literature Review • Medline--1996-2006 • Search Terms: • Patient Education • Evidence-based Medicine • Pharmaceutical Preparations • Consumer Information Products from Other Countries • Description • Compare characteristics

  4. 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

  5. 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

  6. 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

  7. 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.

  8. 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.

  9. Information Products from Other Countries How is risk and benefit communicated to health care consumers?

  10. 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

  11. 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?

  12. 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

  13. 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

  14. Canada Osteoporosis Canada “Drug Treatments” (website)

  15. Brown, et al. CMAJ 2002.

  16. Osteoporosis Society of Canada. Osteoporosis Update 2003.

  17. www.osteoporosis.ca

  18. Osteoporosis Canada: About Osteoporosis--Drug Treatments

  19. New Zealand The New Zealand Guidelines Group HRT—New Information for Women

  20. http://www.nzgg.org.nz/guidelines/0078/HRT_summary_web.pdf

  21. http://www.nzgg.org.nz/index.cfm?fuseaction=download&fusesubaction=template&libraryID=219http://www.nzgg.org.nz/index.cfm?fuseaction=download&fusesubaction=template&libraryID=219

  22. NZGG: HRT—New Information for Women

  23. Australia Australian Acute Musculoskeletal Pain Guidelines Group Acute Low Back Pain

  24. http://www.nhmrc.gov.au/publications/synopses/cp94syn.htm

  25. 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

  26. Australian Acute Musculoskeletal Pain Guidelines Group:Acute Low Back Pain

  27. United Kingdom Statins for the Prevention of Cardiovascular Events

  28. http://www.nhmrc.gov.au/publications/synopses/cp94syn.htm

  29. NICE: Statins for the Prevention of Cardiovascular Events

  30. AHRQ:Effective Health Care ProgramThe John M. Eisenberg Center

  31. Example of an Eisenberg Center Product in Development Choosing Pain Medicine— A guide for people with osteoarthritis

  32. Eisenberg Center: Choosing Pain Medicine—A guide for people with osteoarthritis

  33. 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

  34. 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?

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