Is the NHS willing to help clinicians and patients reduce uncertainties about the effects of treatments?

Abstract

-Uncertainty is an inevitable component of clinical practice. Clinicians have a responsibility to minimise it by keeping up-to-date with current knowledge: but what is the responsibility of individual clinicians in reducing collective uncertainty? In all fields of medicine there are important questions relevant to both patients and clinicians, which can be answered only by clinical research. Unfortunately, much of the clinical research that attracts funding does not address the questions that both patients and clinicians regard as important. Furthermore, although the NHS has a proud record of innovation and clinical research, recent changes are jeopardising the ability and willingness of NHS clinicians to continue undertaking such work. A combination of increased bureaucracy in obtaining research ethics and local research and development (R&D) governance approval and the pressures on management to deliver service targets threaten to strangle research by NHS clinicians. Policy makers argue for informed patient choice, modernisation and improved quality. It is not in the interest of patients when research designed to address important therapeutic uncertainties is seen as an optional extra, rather than an intrinsic element of a health service interested in improving quality. The NHS needs to listen to its users, ie the patients, and to its clinical staff, and to encourage them to engage in research to help reduce those uncertainties. KEY WORDS: health policy, NHS clinical research, patient involvement, psoriasis, uncertaintyThe importance of addressing uncertainties about the effects of treatments Clinicians and patients have to deal with several kinds of uncertainties when selecting treatments from among alternatives. Sometimes they are uncertain because they are unaware of the strength of existing evidence from research, as was the case for many years with thrombolysis in acute myocardial infarction. 1 Even if clinicians and patients are aware of relevant evidence, however, there will almost always be residual uncertainty about whether a treatment known to be helpful on average will help an individual patient: a patient's sensitivity to aspirin, for example, may preclude use of the drug to reduce the risk of cardiovascular disease.Sometimes, a search for reliable evidence about the relative merits of different treatment options will make clear that no such evidence exists -a situation of 'certain uncertainty' . Choices among treatment options in these circumstances may sometimes be driven by strong patient preferences, for example, to avoid surgery. But what are the responsibilities of clinicians when patients have no strong preferences and little or nothing is known about the relative merits and disadvantages of different treatment options? 2 Clinical practice would become impossible if clinicians tried to deal with all such 'informed uncertainties' , and often little harm to patients will result from not doing so. However, acquiescence in 'informed uncertainty' sometimes results in avoidable suffering ...

Comparators, study duration, outcome measures and sponsorship in therapeutic trials of psoriasis: update of the EDEN Psoriasis Survey 2001-2006

“…smoking cessation strategies), manoeuvres to reduce weight in overweight and obese patients, coping strategies, assessment of different settings for providing treatment, and educational interventions. The conduct and publication of independent clinical research taking a broader view on disease management should be encouraged 44 . Public funding sources should be considered for supporting independent research.…”

From the Editor

“…The issues need discussion not only in the context of undergraduate education but even more importantly in the postgraduate training of doctors who need to understand the different notions of uncertainty and how to handle them. Furthermore, resolution of clinical uncertainties should be addressed wherever possible by NHS clinical research, a seriously neglected area addressed in this issue by Chalmers et al 15 The College's Ethics Committee is also discussing approaches to uncertainties in clinical practice. But education regarding uncertainties needs to go beyond that of doctors alone.…”

Do systematic reviews address community healthcare professionals’ wound care uncertainties? Results from evidence mapping in wound care

“…Uncertainty can affect any type of healthcare decision that practitioners may make, such as assessment, diagnosis, intervention, communication, referral, service delivery and organisation, and information-seeking [15]. It has been suggested that increasing the availability of high quality research evidence on topics relevant to patients and healthcare professionals is one way of tackling uncertainties that arise from lack of scientific data [16]; such progress would this requires that the right research is commissioned and conducted.…”