Introduction

The public are increasingly encouraged to trust evidence-based health and social care but are rarely engaged with complex interpretation of research that informs practitioner decisions. In everyday practice, professionals integrate research alongside experience and individual patient factors, yet this reasoning often remains invisible. As access to health information expands and patients take a more active role in decision making, this gap between evidence use and evidence communication risks undermining trust.

Trust is not automatic; it develops through communication, transparency, and confidence that clinicians are both competent and acting in peoples’ best interests.¹,² Evidence-based practice has generally strengthened this by promoting the integration of research evidence, practice expertise, and person-centred values.³ However, as expectations of service-user involvement increase, the visibility of how evidence is used becomes more important.⁴

Significant investment has been made in developing a research-skilled workforce, embedding research activity across health and social care roles.⁵ While this is essential, it may be insufficient on its own. Sustaining trust in modern health and care requires not only the use of evidence, but making it visible, understandable, and open to discussion.

The hidden work of evidence in practice

Practitioners routinely balance multiple sources of information, including research findings, professional experience, and individual circumstances such as comorbidities, lifestyle, and preferences.⁶ Evidence derived from population studies must be interpreted in the context of individual need. This process is complex, rapid, and largely implicit.

In most consultations, service users are presented with recommendations rather than the reasoning that underpins them. While this supports efficiency in time-limited encounters, it limits opportunities for shared understanding. Evidence from shared decision-making studies shows that service users are more likely to feel confident and engaged when they understand how and why decisions are made^7,8 and consideration of developing health and care literate models has grown over the last decade.⁹

From a leadership perspective, this raises an important question: Should implementation of evidence-based practice be judged solely on whether evidence is used, or also on how it is communicated and understood?

Expanding access to evidence: Opportunity and risk

Efforts to make research more accessible are increasing. Plain language summaries, digital platforms, and AI-enabled tools can now translate complex findings into more accessible formats.^10,11 Patient-held records and digital tools are also evolving, with potential to link personal health information to relevant evidence and decision support.¹²

These developments may enhance transparency and support patient engagement. However, they also introduce new challenges. Research evidence is often uncertain, contested, and context-dependent. Simplified summaries may not capture these complexities, and differences between algorithmic outputs and professional judgement can be difficult to interpret.^4,13

Without careful mediation, increased access to information may create confusion rather than clarity. Trust may be weakened if patients are exposed to evidence without support to interpret its relevance and limitations.²

Is a research-skilled workforce enough?

Policy initiatives increasingly position research as a core component of professional roles, with benefits including improved innovation, service performance, and recruitment to clinical studies.¹⁴ However, research activity can and often remains largely invisible to patients and is often constrained by competing service pressures.^15,16

At the same time, health systems expect patients to take a more active role in managing long-term conditions and making decisions beyond clinical settings. This assumes a level of confidence in understanding health information that is not evenly distributed and risks widening inequalities.^17,18 Patients with fewer educational or digital resources may be less able to assess the quality or relevance of evidence, particularly when information is conflicting.

Developing a research-skilled workforce is therefore necessary but not sufficient. Without parallel efforts to support understanding and communication, there is a risk that increased access to information may widen, rather than reduce, inequalities in care.^19,20

Making evidence visible

If trust in healthcare is to be sustained, evidence must be made visible within clinical encounters. This does not mean overwhelming patients with data, but supporting meaningful explanation of how evidence informs decisions, including its uncertainties and limitations.

Clinicians already perform this interpretive work, but it is rarely recognised or resourced. Making evidence visible requires time, training, and system-level support. Digital tools and decision aids may help, but should be designed to facilitate conversations rather than replace them.¹¹

There is also a need to strengthen public understanding of research, so that patients are better equipped to engage with evidence in ways that support, rather than hinder, shared decision making.¹⁰

Implications for leaders

Leaders have a critical role in ensuring that investment in research capacity translates into improved patient experience and trust. This requires a shift in focus from evidence use alone to evidence communication and understanding.

Key priorities include:

• Recognising evidence communication as a core clinical skill, alongside evidence appraisal
• Designing systems and workflows that support transparent conversations
• Investing in tools that link evidence to individual care in accessible ways
• Addressing inequalities in research literacy and digital access
• Valuing and resourcing the interpretive work of evidence use in practice

Conclusion

In an era of abundant information, trust in healthcare can no longer rely solely on professional authority. It must be built through shared understanding. A research-skilled workforce is essential, but insufficient on its own. Evidence must be made visible, interpretable, and relevant to individual lives. Only then can it support both better decisions and stronger relationships in care.

References:

1 Hall, M.A., Dugan, E., Zheng, B. and Mishra, A.K. (2001), Trust in Physicians and Medical Institutions: What Is It, Can It Be Measured, and Does It Matter?. The Milbank Quarterly, 2001;79: 613-639. doi: 10.1111/1468-0009.00223

2 Gilson L. Trust and the development of health care as a social institution. Soc Sci Med. 2003 Apr;56(7):1453-68. doi: 10.1016/s0277-9536(02)00142-9. 

3 Sackett D L, Rosenberg W M C, Gray J A M, Haynes R B, Richardson W S. Evidence based medicine: what it is and what it isn’t BMJ 1996; 312 :71 doi:10.1136/bmj.312.7023.71

4 Greenhalgh T, Howick J, Maskrey N. Evidence based medicine: a movement in crisis? BMJ 2014; 348 :g3725 doi:10.1136/bmj.g3725

5 NHS England. Research in the NHS. London: NHS England; 2024. Available: https://www.england.nhs.uk/long-read/research-in-the-nhs/ (accessed 6 Apr 2026) 

6 Tonelli MR. Integrating evidence into clinical practice: an alternative to evidence-based approaches. J Eval Clin Pract. 2006 Jun;12(3):248-56. doi: 10.1111/j.1365-2753.2004.00551.x. PMID: 16722902.

7 Charles C, Gafni A, Whelan T. Shared decision-making in the medical encounter: What does it mean? (or it takes at least two to tango). Soc Sci Med. 1997;44(5):681–92. doi: 10.1016/S0277-9536(96)00221-3

8 Elwyn G, Frosch D, Thomson R, Joseph-Williams N, Lloyd A, Kinnersley P, Cording E, Tomson D, Dodd C, Rollnick S, Edwards A, Barry M. Shared decision making: a model for clinical practice. J Gen Intern Med. 2012 Oct;27(10):1361-7. doi: 10.1007/s11606-012-2077-6. 

9 Koh HK, Brach C, Harris LM, Parchman ML. A proposed ‘health literate care model’ would constitute a systems approach to improving patients’ engagement in care. Health affairs. 2013 Feb 1;32(2):357-67. Accessed at 

10 National Institute for Health and Care Research. Plain English summaries. London: NIHR; 2021. Available: https://www.nihr.ac.uk/plain-english-summaries (accessed 6 Apr 2026)

11 Topol, E.J. High-performance medicine: the convergence of human and artificial intelligence. Nat Med 2019;25, 44–56. doi: 10.1038/s41591-018-0300-7

12 Brands M, Gouw S, Beestrum M, Cronin R, Fijnvandraat K, Badawy S. Patient-Centered Digital Health Records and Their Effects on Health Outcomes: Systematic Review. J Med Internet Res 2022;24(12):e43086 doi: 10.2196/43086

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14 Boaz A, Hanney S, Jones T, Soper B. Does the engagement of clinicians and organisations in research improve healthcare performance: a three-stage review. BMJ Open. 2015 Dec 9;5(12):e009415. doi: 10.1136/bmjopen-2015-009415.

15 Shepherd M, Endacott R, Quinn H. Bridging the gap between research and clinical care: strategies to increase staff awareness and engagement in clinical research. J Res Nurs. 2022 Mar;27(1-2):168-181. doi: 10.1177/17449871211034545. 

16 Sashka D, Rob P, Sarah B, Amelia H, Asha C, Sonja M. Enabling NHS Staff to Contribute to Research: Reflecting on Current Practice and Informing Future Opportunities. Rand Health Q. 2020 Jun 15;8(4):RR-2679-THIS. PMID: 32582467; PMCID: PMC7302317.

17 Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Crotty K. Low health literacy and health outcomes: an updated systematic review. Annals of Internal Medicine. 2011 Jul;155(2):97-107. DOI: 10.7326/0003-4819-155-2-201107190-00005. PMID: 21768583.

18 NHS England. Inclusive digital healthcare: a framework for NHS action on digital inclusion. London: NHS England; 2023. Available: https://www.england.nhs.uk/long-read/inclusive-digital-healthcare-a-framework-for-nhs-action-on-digital-inclusion/ (accessed 6 Apr 2026)

19 Smith QW, Street RL, Volk RJ, Fordis M. Differing Levels of Clinical Evidence: Exploring Communication Challenges in Shared Decision Making: Exploring Communication Challenges in Shared Decision Making. Medical Care Research and Review. 2013;70(1_suppl):3S-13S. doi:10.1177/1077558712468491

20 Alston C, Paget L, Halvorson G, Novelli B, Guest J, McCabe P, Hoffman K, Koepke C, Simon M, Sutton S, Okun S. Communicating with patients on health care evidence. NAM Perspectives. 2012 Sep.

Author

Lisa Bunn