Those of you in the UK may be struggling to work out exactly which PPI is in this title: is it payment protection insurance? (no); is it that old government/company hospital building thing? (no, and that was private finance initiative, PFI); is it ‘patient public involvement’? Yes! The active engagement of people who use the health services in developing the services and research into health and disease.
How does PPI work with reviewing ‘evidence’ though? It’s not one of the tickboxes in the CASP checklists, nor is in in our RAMBo, AVID or FAST criteria. Is PPI something only of relevance to the ‘doer’ of research not the ‘user’?
We’ve argued previously about the use of the patient’s voice, their specific question and views on the balance of risk of benefits and harmful outcomes, as being key to the practice of evidence based medicine. What I think we should probably be asking more is of the original research we are appraising – where was the patient/family in the design and delivery of this research? Why were these outcomes reported on? Can I be assured the meaningful bits I don’t know about because I’m a doctor/nurse/physio looking ‘in’ on this rather than a patient/sibling/carer having the condition have been considered? If we don’t see this, we should probably be waving a little warning flag, the same way we would if we didn’t know what the allocation system was, or if the those assessment scales were used by trained assessors. We could possibly go further, to enquire if the PPI undertaken was of ‘good quality’, but the scholarship in the undertaking of PPI may not quite be up to doing this robustly yet.
Does PPI definitely make things better? We don’t know for certain. But we know it has altered what researchers have understood, undertaken and sought to align things closer to the wishes of those affected. As it stands, I think we should progress with a ‘Probably Yes’.