The most critical part of the process of improving health care decision-making for patients and providers is the communication and dissemination of the most accurate, up-to-date information related to a diagnostic or treatment decision. An Agency for Healthcare Research & Quality report looks at the research base on various strategies and techniques for communication and dissemination of health-related evidence. (AHRQ Report) The most striking finding is how little good research has been done in this critical area. But the report provides an excellent discussion and identification of various communication and dissemination issues. Dissemination tends to be used to refer to the active transmission of information about a health test or treatment to doctors, as opposed to diffusion, which generally is a study of non-intentional uptake of those tests or treatments. The channels used for dissemination, as well as the presentation of content, can make a meaningful difference in the adoption of desired physician behaviors.
Similarly, for patients it is even more critical to have an effective method of communication, and that method may vary by patient–some may prefer to see a video, some may want to read information and some may respond best to an individual conversation in which a doctor or other health professional goes over the information with them. Health-related evidence can be difficult to understand and it is hard to avoid statistics when discussing likely outcomes and risks, and how that information is presented–in text, graphically, etc., can have an impact on how well it is understood. It is also particularly difficult to help patients understand how certain a piece of health-evidence is; how much risk is there that it doesn’t portray reality.
The authors found about 60 articles with relevant study descriptions, but these were highly variable in what they were testing, so it is hard to find “strong” evidence supporting any particular technique. It does not appear that generally using either messages tailored to an individual or targeted to a group produced better results, but in some cases those techniques might have led to better results. Loss-framed messages were more persuasive than gain-framed ones. Multicomponent dissemination strategies aimed at physicians were better than single tactic interventions at inducing behavior change, particularly in regard to guideline adherence. Overall the report strongly suggests that much more research is needed in this important area of improving health care quality and decision-making.