Effectiveness of strategies for informing, educating, and involving patientsBMJ 2007; 335 doi: https://doi.org/10.1136/bmj.39246.581169.80 (Published 05 July 2007) Cite this as: BMJ 2007;335:24
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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
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-
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.
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
Competing interests: No competing interests
Online on-the-spot searching increases use of evidence in sharing decision making during consultations
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
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
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
(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
(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: No competing interests