What counts as relevant evidence? Physicians disagree

Providing physicians with evidence from scientific publications when they need it may be the gold standard in evidence-based medicine, but there is a problem. Clinicians do not necessarily agree on what evidence is most useful to them at the point of care to manage a patient.

Researchers from City University London, the Telfer School, CHEO and Poznan University of Technology recently completed a survey of twenty-two pediatric emergency physicians from teaching hospitals across Canada. They asked them to assess the relevance of evidence in the form of systematic reviews for a common set of patient cases. In particular, systematic reviews from the Cochrane Library, a widely used source of best evidence in medicine, were retrieved automatically for 14 patient profiles: pediatric patients with asthma exacerbations presenting at the emergency department. Evaluating the evidence presented, the physicians gave opinions ranging from “very relevant” for a patient case to “irrelevant,” with the majority of evaluations falling somewhere in the middle.

There was, in other words, no consensus on what constitutes relevant clinical evidence for a given patient case, and physicians’ perceptions of relevance were clearly influenced by different factors. This finding suggests that when presenting evidence at a point of care, the evidence “needs to be highly customized with regards to physicians’ preferences and factors specific to a culture of a clinical setting.” The study was by D. O’Sullivan, S. Wilk, C. Kuziemsky, W. Michalowski, K. Farion and B. Kuwawka. All are affiliated with the Mobile Emergency Triage (MET) research group at Telfer, which conducts studies focused on providing computer-based support for a number of decision problems that occur at the point of care in a healthcare institution. Read the abstract and find out more.