Differing Levels of Clinical Evidence

Abstract

The near ubiquitous access to information is transforming the roles and relationships among clinical professionals, patients, and their care givers in nearly all aspects of healthcare. Informed patients engage their physicians in conversations about their conditions, options and the tradeoffs among diagnostic and therapeutic benefits and harms. The processes of care today increasingly and explicitly integrate exploration of patient values and preferences as patients and clinicians jointly engage in reaching decisions about care. The informed patient of today who can understand and use scientific information can participate as an equal partner with her clinician. Others with beliefs or educational, cultural, or literacy backgrounds that pose challenges to comprehending and applying evidence may face disenfranchisement. These barriers are significant enough, even in the face of certainty of evidence, that clinicians and investigators have given much thought to how best to engage all patients in decision making. However, barriers remain, as most decision making must occur in settings where uncertainty, if not considerable uncertainty, accompanies any statement of what we know. In September 2011, health care and health communication experts came together in Rockville, Maryland under the auspices of the Agency for Healthcare Research and Quality (AHRQ) John M. Eisenberg Center for Clinical Decisions and Communications Science Annual Meeting to explore the challenges of differing levels of evidence in promoting shared decisions and to propose strategies for going forward in addressing these challenges. Eight scholarly papers emerged, and with this introductory article, comprise this special issue of Medical Care Research and Review.

Perceptions of Equipoise, Risk–Benefit Ratios, and “Otherwise Healthy Volunteers” in the Context of Early-Phase HIV Cure Research in the United States: A Qualitative Inquiry

“…As the number of HIV cure clinical studies is quickly increasing (Treatment Action Group, 2017), more precise information about potential risks is needed. Furthermore, as the field increasingly embraces a public health and epidemiological approach to HIV cure research, we need to account for individual variations and unpredictability of risks in various participant populations and contexts (Rossouw, Tucker, van Zyl, Sikwesi, & Godfrey, 2017; Smith, Street, Volk, & Fordis, 2013).…”

English Language Proficiency, Health Literacy, and Trust in Physician Are Associated with Shared Decision Making in Rheumatoid Arthritis

“…Specific barriers include health beliefs, and educational, cultural, or literacy backgrounds that pose challenges to understanding or applying existing evidence to certain decisions, such as whether or not to begin a biologic or triple therapy with synthetic DMARDs when faced with moderate to high disease activity. Such barriers can then result in disenfranchisement or further alienate patients from fully engaging in healthcare decisions (45). …”

Estimation of Risk of Recurrence and Toxicity Among Oncologists and Patients With Resected Breast Cancer: A Quantitative Study

“…On the other hand, they feel that SDM is more difficult when they perceive a higher risk of relapse. Smith et al (2013) report that discussing uncertainty and risks challenges patientclinician communication; therefore, when the physician finds himself/herself in a complex situation, he/she may feel more uncomfortable with SDM.…”