Analysis of clinical uncertainties by health professionals and patients: an example from mental health

Abstract

BackgroundThe first step in practising Evidence Based Medicine (EBM) has been described as translating clinical uncertainty into a structured and focused clinical question that can be used to search the literature to ascertain or refute that uncertainty. In this study we focus on questions about treatments for schizophrenia posed by mental health professionals and patients to gain a deeper understanding about types of questions asked naturally, and whether they can be reformulated into structured and focused clinical questions.MethodsFrom a survey of uncertainties about the treatment of schizophrenia we describe, categorise and analyse the type of questions asked by mental health professionals and patients about treatment uncertainties for schizophrenia. We explore the value of mapping from an unstructured to a structured framework, test inter-rater reliability for this task, develop a linguistic taxonomy, and cross tabulate that taxonomy with elements of a well structured clinical question.ResultsFew of the 78 Patients and 161 clinicians spontaneously asked well structured queries about treatment uncertainties for schizophrenia. Uncertainties were most commonly about drug treatments (45.3% of clinicians and 41% of patients), psychological therapies (19.9% of clinicians and 9% of patients) or were unclassifiable.(11.8% of clinicians and 16.7% of patients). Few naturally asked questions could be classified using the well structured and focused clinical question format (i.e. PICO format). A simple linguistic taxonomy better described the types of questions people naturally ask.ConclusionPeople do not spontaneously ask well structured clinical questions. Other taxonomies may better capture the nature of questions. However, access to EBM resources is greatly facilitated by framing enquiries in the language of EBM, such as posing queries in PICO format. People do not naturally do this. It may be preferable to identify a way of searching the literature that more closely matches the way people naturally ask questions if access to information about treatments are to be made more broadly available.

Great expectations for participatory research: what have we achieved in the last ten years?

“…In developing questions to answer in the field of schizophrenia, there were 237 priorities identified, which through discussion were reduced to 26 highly ranked (via surveys). The next step was a face‐to‐face meeting where the list was reduced to 10 priorities of the form “what is the best way to treat people with schizophrenia who are unresponsive to treatment?” . These priorities are now being adopted by research funders .…”

“…The next step was a face-to-face meeting where the list was reduced to 10 priorities of the form "what is the best way to treat people with schizophrenia who are unresponsive to treatment?" (9,10). These priorities are now being adopted by research funders (11).…”

Book edited by MargaretPack and JustinCargill. 2015: Harrisburg, PA, Idea Group. ISBN: 978‐1‐466665‐63‐7

“…Here are areas in need of exploration: What do social workers in different settings actually do? What are important information needs of social workers and clients? (e.g., Lloyd, Cella, Tanenblatt, & Coden, ) What percentage of social workers pose clear questions regarding information needs (important uncertainties), and what are these questions? What percentage are answered (e.g., revealing that no related research is available)? What variations in practice occur?…”

Precision medicine: Driving the evolution of biobanking quality

“…Patients today expect that the healthcare offered to them is based on the best evidence available; however, it has been demonstrated by numerous studies that within Canada, patients often receive healthcare that is not supported by adequate evidence. 2 For example, fewer than 60% of decisions in general medical services have the support of adequate evidence [3][4][5] and up to 25% of patients receive care that is unnecessary or potentially harmful. 6 A factor that seems to underpin the issue of these gaps in evidence-based medicine in Canada is the persistent view that research is separate from healthcare.…”