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New international project to support evidence in practice and policy

DECIDE is a new international collaborative research project for developing and evaluating strategies for communicating evidence-based recommendations and policy briefs.

In the article below, one of the researchers involved in the project, Andy Oxman from the Norwegian Knowledge Centre for the Health Services, provides an overview of DECIDE.

***

Helping inform patients, clinicians and policymakers

Andy Oxman writes:

Health professionals, patients, policymakers and the public all want to make healthcare decisions that are informed by the best available research evidence. This requires reliable summaries (systematic reviews) of the evidence of the advantages and disadvantages of our options. It also requires complex judgements.

Systematic reviews of the effects of healthcare provide essential, but not sufficient information for making well informed decisions.

Review authors and people who use reviews draw conclusions about the quality of the evidence (how confident we can be in the estimates of effects), either implicitly or explicitly. Such judgments guide subsequent decisions. For example, clinical actions are likely to differ depending on whether one concludes that the evidence that warfarin reduces the risk of stroke in patients with atrial fibrillation is convincing (high quality) or that it is unconvincing (low quality).

Similarly, policy decisions are likely to differ depending on whether one concludes that the evidence that specialised stroke units reduce the risk of death and disability (compared with treating acute stroke patients in general medical wards) is convincing or not.

The GRADE Working Group is a collaboration of over 60 organisations from around the world that has developed a systematic and transparent approach to making judgments about the quality of evidence (how confident we are in estimates of effect) and the strength of recommendations (how confident we are that the desirable effects of adherence to a recommendation outweigh the undesirable effects).

To benefit from this work, health care decision makers need to have access to evidence-based clinical recommendations or briefs describing policy options, they need to be able to understand that information and they need to be enabled to make decisions that reflect their own values or the values of those affected.

DECIDE is an international collaborative research project linked to the GRADE Working Group that will develop and evaluate strategies for communicating and disseminating evidence-based recommendations and policy briefs.

These strategies will be tailored to the information needs of patients, clinicians and policymakers. They will include frameworks to help people to go from evidence to decisions, as well as strategies for communicating research findings.

For example, the DECIDE framework for health policy decisions reflects the need to consider evidence and judgements about a number of factors that can (and should) influence such decisions. These factors include the seriousness of the problem (e.g. strokes), the number of people affected (e.g. by acute strokes), the quality of the evidence, the size of the desirable effects (e.g. reduced deaths and disability), the size of the undesirable (adverse) effects, the resources that are required, cost-effectiveness (value for money), impacts on equity, feasibility and acceptability.

A framework to help decision makers and stakeholders to systematically and transparently consider each of these factors and the underlying evidence for each of these can help to ensure that important considerations are not overlooked and that consideration of each factor is informed by the best available evidence. It might also help to ensure that decisions are not inappropriately influenced by conflicts of interest, irrelevant information or unsubstantiated assumptions.

The DECIDE project started in January 2011 and will run for five years.

It has received funding from the European Union 7th Framework Programme (FP7/2007-2013) under grant agreement number 258583. More information about the project can be found on our web pages.

 

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