Cochrane Colloquium Videos 2013: Plenary 2
Posted on 5th November 2013 by Alice Buchan
After reviewing some of the key points for thought and discussion from the first session’s talks here, I’ve had a look at the talks from the second session, and here are my musings. This session of the Cochrane Colloquium was entitled: “Better Knowledge for Better Healthcare.”
Dr John N. Lavis
This talk was about knowledge for health system managers and policy makers – so evidence-based medicine on a very grand scale, compared to the individual patient scale we often consider. Evidence-informed policy, including at a global level, has huge potential in terms of improving outcomes for innumerable patients. As discussed in his talk, this is presently being done by means of user friendly summaries of systematic reviews and syntheses of evidence, as well as evidence briefs. The idea behind using evidence to inform policy is simple. It’s about how to get cost-effective care to the people who need it, and it works from Canada to Uganda and across the world. That isn’t to say that one synthesis of evidence fits all countries – currently many Cochrane reviews of health systems evidence do not focus on low/middle countries.
What is interesting about systems and policy evidence is that it is not just about the care that is delivered but how it is done, and the system around that. One key issue he identified is that reviews of systems are heavily prone to influence by political and other ideology, which can be difficult to tease out. Like evidence that informs practice, health systems evidence needs to be high quality, up to date, and also context dependent.
Dr Jimmy Volmink
His talk was about knowledge for healthcare professionals, more specifically education and training of health professionals. As a health professional of the future, the idea of evidence-based teaching and training was not something I had previously considered, but which now seems patently obvious. In order to have the best possible clinicians to deliver high quality patient care, we should find out what the best way of achieving that is, and apply the evidence to improve training. One pertinent point raised was that most Cochrane authors involved with Universities so either do, or can influence teaching. If not just what you learn but how you learn it should be evidence-based, then is it? One major source mentioned was a report in the Lancet, which suggested that presently systematic reviews are not relied upon that heavily when informing how medical education is undertaken. The health and education systems are interdependent, which as a student, affiliated to both the hospital and my university, is obvious, but I think may be lost when decisions about training are being made. This report highlighted a role for transformative learning including gaining the skills to be able to analyse and synthesise information for decision making rather than rote learning facts. The BEME Collaboration for evidence based medical education, mentioned at the end of the talk, aims to promote evidence-based medical education.
This talk left me with two (sets of) questions.
- Am I learning and being taught in the best possible way? What is the evidence to back that up?
- Is my way of teaching pre-clinical students a good way? What is the evidence that could inform my teaching?
I still don’t know the answers to any of those questions. I should probably go look at some evidence.
Dr France Légaré
Dr Légaré’s talk was entitled, “Promoting shared decision-making for better decisions and health”, and was based on the premise that every day lots of clinical decisions are made in the ‘grey zone’ of varying degrees of uncertainty about the treatment decision. One quote that resonated with me from her talk was this: “shared decision making is about people.” I think it really can be that simple, as so much of healthcare is about people, rather than pathological processes. The idea of a collaboration between the patient and their healthcare provider is really important, and whilst my personal experience suggests we are moving on from an old-fashiond ‘doctor-knows-best’ approach, the evidence presented in the talk suggests that shared decision-making is currently not happening all that much.
Perhaps unsurprisingly, implementation of shared decision-malign was. most effective when both clinician and and patient educated about shared decision making (including decision support tools). This resonated with me as we are all patients as well as medics and that provides an interesting perspective. As Dr Légaré said, “both clinician and patient need access to evidence at the point of care.” I would like to think that when being presented with treatment options as a patient, the healthcare provider is not just using the evidence, but sharing it with me, especially where I as the patient might be given a choice of investigations or treatments. I think that I’m particularly in favour of this as a medical student with an interest in evidence-based medicine, but I’m sure lots of other patients who do not have a medical background would also want to know.
The Intersection Between Evidence-Based and Patient-Centered Healthcare was the title of this session’s final talk, which was about the role(s) of patients in research. Patients and researchers don’t necessarily have the same ideas about patient engagement in research. Whilst there is some engagement of patients in Cochrane reviews, particularly in plain language summaries, there was the suggestion that consumer involvement in Cochrane could be extended beyond what it is presently. I think the key message from this talk is that consumer participation should be meaningful and not token. The phrase from the talk that has stuck, however, is that, “culture eats strategy for lunch.”