Patient Perspectives on Evidence-Based Medicine

Using “evidence” to guide medical diagnosis and treatment seems obvious.  What the “evidence” is, however, has proven more difficult to define and getting clinicians to practice according to the evidence is even harder.  So maybe it isn’t surprising that consumers are confused at times.  Researchers conducted in-depth forums with 907 people to ascertain views on use of evidence-based medicine, and the results are published in a Health Affairs article.   (HA Article)   Patients are increasingly encouraged to participate in decisions about their medical care, therefore they need to be able to understand the evidence about various treatments.  And the patient public should be permitted to have input into decisions about treatment guidelines supposedly based on evidence.  Participants had access to materials about evidence-based medicine before the deliberative session.  There was a general discussion at the session about use of evidence and also a focussed discussion on five sample case studies.  Participants also completed surveys.

While participants generally said evidence was important and should be used in making medical decisions, they also felt that “one-size fits all” approaches should be rejected and individual differences may make generalized evidence less relevant to specific decisions.  Most participants said doctors should not be able to provide a treatment for a patient if evidence concluded it wouldn’t work, but should be able to if study results showed it might work.  Similarly, while some people think patients should be able to get treatments that research shows won’t work, most don’t agree with that, but do think that if there is a chance the treatment could work for the person, they should be able to choose it.  Participants had a high level of trust that doctors would weigh the evidence and make an appropriate decision.  And they were very reluctant to limit patient choices unless the evidence against use of a treatment was completely overwhelming.  If there was evidence of possible individual or community harm, however, from use of certain treatments, participants were more willing to accept limits on the treatment.  In most respects, the study indicates that consumers may be wiser about use of “evidence” in medicine than many policymakers, especially academic ones, are.  And if these participants had been told how often the evidence changes, even on major treatment issues, like blood pressure control, or appropriate ranges for blood sugar for diabetics, they likely would have been even more skeptical about evidence-based mandates.