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Online on-the-spot searching increases use of evidence in sharing decision making during consultations
- Dirk Van Duppen, Annelies Van Linden (8 July 2007)
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Patient-Centred care
- Caroline S Flood, Mansfield, NG17 4JT (9 July 2007)
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Dirk Van Duppen, GP Group Practice ‘Doctors for the People’, Deurne, Belgium, Annelies Van Linden
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Coulter and Ellins demanded ‘widespread implementation of innovations to improve decision making and promote greater patient involvement’.(1) We developed ‘Online on-the-spot’ (OOS) as a quality improvement project. It aims to efficiently answer doctors’ educational needs and the patients’ unmet needs, by searching for online evidence in a structured way in consultation with the patient. The concept has its origins in a formula developed by Slawson and Shaughnessy U = (R x V x I)/W.(2) Where U is the usefulness of the information, R the relevance, V the validity, I the interaction and W is the work to access the information. In OOS the relevance (R) of the search has to meet the criteria of a POEM: the paper addresses a question that doctors encounter, it measures outcomes that doctors and their patients care about and it has the potential to change the way doctors practise. The validity (V) of the online information is high if we use websites with relevant evidence-based information. The amount of work (W) and time to search is minimal and the information available in full text can be immediately implemented at the point of care. Instead of a full and broad search on evidence, we focused on sources with already appraised evidence, such as clinical guidelines, especially Prodigy and Dutch GP guidelines. The interaction with the patient (I) is also high because it’s his problem that leads to the question, he can follow the search, waits on an answer and he expects an explicit translation of the relevant information into a language that he can understand. We registered the OOS-hits during three months.(3) For each eight patient–doctor contacts, we did one search online. We found an answer in more than eight searches out of ten. In four cases this produced new information and in one search out of four the GP changed his decision. In nearly half of the searches the patient participated together with his doctor, concerning the search. Once a doctor was familiar with the method, the time spent on a search and interacting with the patient was less than 5 min in more than 50% of cases. OOS connects the patient, the doctor and the evidence. (1) Coulter A, Ellins J. Effectiveness of strategies for informing, educating, and involving patients. Brit Med J 2007;335:24-27. (2) Slawson DC, Shaughnessy AF. Teaching evidence-based medicine: should we be teaching information management instead? Acad Med 2005;80:685–9. (3) Van Duppen D, et al., Online on-the-spot searching increases use of evidence during consultations in family practice, Patient Educ Couns (2007), in Press. Competing interests: None declared |
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Caroline S Flood, Specialist Registrar in Psychiatry Millbrook Unit, Kingsmill Hospital, Mansfield, NG17 4JT
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I was pleased to read an article which promotes a patient-centred approach to healthcare, particularly one which provides the evidence base to promote patient involvement in their own health services. Scientific and technological advances give us an ever-more complex evidence base for health-care decisions and thus reveal an ever-widening range of choices in health care (Woodbridge, 2004). As soon as there are choices, then it is patients’ values which will determine the choices they make. In the 1980s, when the patient-centred clinical method was first being developed and used in research and education, it was at the periphery of medicine, and was regarded by many as being a "soft science" (Stewart et al, 2003). This view has remained for many, particularly when the patient-centred method is compared to the "hard science" of evidence- based medicine. There is no reason why a subjective, values-based approach cannot sit alongside the objective, factual approach, and concerns about conflict between values-based practice and Evidence Based Medicine are unfounded. To be patient-centred we must have a strong understanding of the factual evidence, but also understand the patient’s unique set of values and experiences. This is an aspect which is highlighted in EBM, which promotes the integration of three key elements: best research evidence, clinical expertise and patient values (Sackett et al, 2000). In order to do this effectively there should be application of the patient-centred ethos in taking into account the illness experience, the person and the context in which the illness presents in order to find common ground between both the physicians and the patient's perspective. It is easy as doctors (who have received many years of scientific training) to take the biological, objective stance in regard to our patients’ care, and investigate the disease process presented to us. I suggest that it is much harder to take the approach of looking at the subjective experience of illness in the person in front of us. This is what is required in addition to the biological position for a balanced, truly patient-centred approach. References Sackett DL, Strauss SE, Scott Richardson W, Rosenberg W & Haynes RB, 2000. Evidence-Based Medicine: How to Practice and Teach EBM (2nd Edition). Churchill Livingstone, Edinburgh. Stewart M, Brown JB, Weston WW, McWhinney I, McWilliam CL & Freeman TR, 2003. Patient-Centred Medicine. Transforming the clinical method. Radcliffe Medical Press, Oxford. Woodbridge K, Fulford KWM, 2004. Whose values? A workbook for values -based practice in mental health care. The Sainsbury Centre for Mental Health, London. Competing interests: None declared |
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