Evidence Live 2016: Promoting informed healthcare choices by helping people assess treatment claims

Iain Chalmers, Paul Glasziou, Douglas Badenoch, Patricia Atkinson, Astrid Austvoll-Dahlgren, and Andy Oxman.

In the run up to Evidence Live 2016, we are running a series of blogs by the conference speakers discussing what they will be talking about at the conference.

All of us are bombarded by treatment claims. These reach us through the media, from people selling treatments, from academics, from health professionals, and from relatives, friends, and people we happen to bump into.

How should people making health choices assess the trustworthiness of such claimed effects of treatments? In particular, how should research evidence play into our assessment of these treatment claims—whether for treatments for something as trivial as a cold, or as life threatening as cancer, or anything in between? Whatever the issue, those making treatment choices have the greatest vested interest in knowing how to go about assessing claims about the effects of treatments because it is they who stand to lose or benefit from the choices they make.

Not all treatment claims are equal

We should assume that everyone who initiates claims about the effects of treatments—or the relative merits and disadvantages of alternative treatments—is influenced by considerations other than trustworthy research evidence. Bias, financial conflicts and errors of omission are rife.

Most of us would want to take account of trustworthy research evidence, but what is trustworthy evidence?” And how can people recognise it when they see it?

Addressing this challenge is the rationale for promoting informed healthcare choices as part of general knowledge. People need help to assess claims about the effects of treatments.

A collaboration to promote informed critical thinking about treatment claims

The Informed Healthcare Choices project, working with the James Lind Initiative, is tackling this challenge. Taking as its starting point the book Testing Treatments (now translated into over a dozen languages), the project began by identifying 32 Key Concepts that people need to understand when assessing treatment claims. A bank of multiple choice questions to test people’s understanding of these Key Concepts has been created and is currently undergoing rigorous evaluation in several countries, including the UK. Based on a subset of the Key Concepts, learning materials (a comic book, a teachers’ guide, games, and podcasts) have been developed initially for Ugandan primary school children and their parents. The learning materials have been piloted and user tested in Uganda, Kenya, Rwanda, and Norway. Importantly, the effects of these learning resources are now being assessed using randomised trials in Uganda, and further trials using similar materials are being planned in Australia.

What works best in teaching people how to assess treatment claims?

There are plenty of learning and teaching resources designed to improve lay understanding of research to test the effects of treatments. However, very few of these have been assessed using controlled trials to find out whether these resources have intended effects on knowledge, attitudes, or behaviour.

People promoting the principle of using trustworthy evidence to guide treatment choices should not acquiesce in the lack of evidence about the effects of these learning and teaching resources. The Fair Comparisons Network has been established as a forum for people interested in improving and evaluating learning and teaching resources. Readers interested in joining the Network’s email list should notify Patricia Atkinson at patkinson@jameslind.net.

Between 1978 and 2003, Iain Chalmers helped to establish the National Perinatal Epidemiology Unit and the Cochrane Collaboration. Since 2003 he has coordinated the James Lind Initiative’s contribution to the development of the James Lind Alliance, the James Lind Library, Testing Treatments interactive, and REWARD. Competing interests: IC declares no competing interests other than his NIHR salary, which requires him to promote better research for better healthcare.

Paul Glasziou is professor of evidence based medicine at Bond University, and chairs the International Society for Evidence Based Health Care. His research focuses on improving the clinical impact of research. As a general practitioner, this work has particularly focused on the applicability and usability of published trials and systematic reviews. Competing interests: None declared.

Douglas Badenoch is an information specialist providing consultancy and project management services in evidence-based health care. Competing interests: Douglas founded and works for Minervation Ltd, a private company providing knowledge services in evidence-based health care.

Patricia Atkinson is Administrator of the James Lind Initiative, which aims to promote better research to inform better health care, particularly through greater public involvement in research. She assists with updating and administering the development of Testing Treatments interactive, and the sourcing, preparation and uploading of documents for The James Lind Library. No competing interests.

Astrid Austvoll-Dahlgren is a senior researcher at the Norwegian Institute for Public Health with a background in the social sciences and community medicine. Her main research interest over the past 14 years has been in systematic reviews and in developing and evaluating interventions to facilitate informed health decision making. She is also part of the editorial team of Testingtreatments.org. No competing interests.

Andy Oxman works as a health services researcher in the Global Health Unit at the Norwegian Institute of Public Health. His research over the past three decades has focused on ways of helping people to make informed choices about healthcare. No competing interests.