Abstract

Plain English summaryWithin health services research in the UK, there has been growing interest in evidence-based medicine (EBM) and patient and public involvement (PPI) in research. These two movements have a common goal of improving the quality and transparency of clinical decision making. So far, there has been relatively little discussion about how these two movements might relate to each other, despite their common concern. Indeed, some in the PPI movement have expressed doubts about the implications of EBM for PPI because they worry that its emphasis on evidence from clinical trials marginalises the importance of a patient’s individual experiences in clinical decision making. The purpose of this paper is to examine the potential for EBM and PPI to complement one another.We analysed the feedback of 10 members of the Peninsula Public Involvement Group (PenPIG) who attended EBM workshops. These workshops trained people in the basics of EBM and were primarily attended by health professionals. We used thematic analysis, a qualitative data analysis method, to explore the responses. We found that participation in the workshops appears to have increased the ability and confidence of members of the public to actively participate as both producers and consumers of research evidence. We conclude that there is an untapped potential for EBM and PPI to complement one another in their shared desire to improve the quality and transparency of clinical decision making.Background Within the UK, health services research in the 1990s was marked by growing interest in evidence-based medicine (EBM) and in the potential of patient and public involvement (PPI) in research. However, there has been relatively little discussion of how these two developments might relate to each other, despite their common concern to improve the quality and transparency of clinical decision making. Indeed, some in the user involvement movement have expressed doubts about the implications of EBM for PPI. The purpose of this paper is to examine the potential for EBM and PPI to complement one another. Methods We used a case study design. Fifteen EBM workshops, involving PPI members, were conducted between June 2010 and December 2014. All 13 lay participants, who attended the first five workshops, were asked to fill in a standard feedback proforma designed by a member of the NIHR Collaboration for Leadership in Applied Health Research and Care for the South West Peninsula (PenCLAHRC) Public Involvement Group (PenPIG). Ten responses were received, and these were analysed thematically. Results Four themes emerged from the thematic analysis: research knowledge, research skills, shared clinical decision making and learning environment. Participation in the workshops appears to have increased the ability and confidence of members of the public to actively participate as both producers and consumers of research evidence. Conclusions There is an untapped potential for EBM and PPI to complement one another in their shared desire to improve the quality and transparency of clinical decision making.

Highlights

  • Introduction to the concept of evidence-based medicine (EBM)10.00 Formulating a focused questionFocus recent clinical questions using the PICO formula.10.45 Tea, coffee and networking11.00 Tracking down the evidenceUse key online resources to locate evidenceApply PICO to search techniques12.30 Lunch1.30 Critical appraisal of an RCTOverview of the critical appraisal purpose and processExperience of using a critical appraisal tool3.00 Tea, coffee and networking

  • Four themes emerged from the thematic analysis: research knowledge, research skills, shared clinical decision making and learning environment

  • There is an untapped potential for EBM and patient and public involvement (PPI) to complement one another in their shared desire to improve the quality and transparency of clinical decision making

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Summary

Introduction

Introduction to the concept of EBM10.00 Formulating a focused questionFocus recent clinical questions using the PICO formula.10.45 Tea, coffee and networking11.00 Tracking down the evidenceUse key online resources to locate evidenceApply PICO to search techniques12.30 Lunch (and networking)1.30 Critical appraisal of an RCTOverview of the critical appraisal purpose and processExperience of using a critical appraisal tool3.00 Tea, coffee and networking. UK, health services research in the 1990s was marked by growing interest in evidence-based medicine (EBM) and in the potential of patient and public involvement (PPI) in research. EBM: definition and origin David Sackett proposed what is a widely accepted definition of evidence-based medicine (EBM). “Evidence based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients” [1]. Sackett goes on to elaborate on the three cornerstones of EBM: individual clinical expertise, best available clinical evidence and individual patients’ situations, rights and preferences. Throughout the 1980s, a McMaster University team, including Sackett, worked to develop a practical method to apply the principles of clinical epidemiology to the delivery of healthcare [4]. EBM has enjoyed a rapid growth of influence, for example, via incorporation into medical curricula, and has been brought to public attention through popular publications such as Ben Goldacre’s Bad Science [7]

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