A campaign to put patient care at the centre of evidence-based medicine (EBM) is launched today by Professor Trish Greenhalgh, Public Health expert at Queen Mary University of London, at the BioMed Central’s Health Services Research conference at Kings’ College London.
The ‘Campaign for real EBM’, a collaboration with the University of Oxford’s Centre for Evidence Based Medicine, aims to combat some the unintended consequences of the EBM movement, whilst acknowledging its achievements so far.
The evidence-based medicine movement began more than 20 years ago. Its aim has been to ensure the treatments used in clinical practice are justified through evidence – especially evidence derived from clinical trials (in which patients are randomly allocated to one treatment or another) used in combination with practical clinical knowledge and awareness of the needs of patients. The evidence-based approach replaced the traditional practice of relying on accumulated clinical experience and reasoning from basic science discoveries in a laboratory.
Clinical trials and other types of research aim to provide evidence; showing whether a particular treatment works, how well it works compared to other treatments, and what the risks of the treatment may be. Different organisations collate the results of clinical trials and other research to determine the evidence for various treatments and procedures.
Evidence-based medicine has seen success stories, such as NICE’s evidence-based guidelines on blood clots (venous thromboembolism) after surgery first launched in 2007. Following publication of the guidelines there was a steady uptake of the recommendations and a significant reduction in post-surgery complications.
However, the campaign highlights that EBM has also seen problems that should be of concern to clinicians, patient advocates and policymakers, amongst others. These concerns include the misuse of the ‘evidence-based’ kitemark by those with conflicts of interest; the ever-increasing and unmanageable volumes of evidence; patients’ voices going unheard; and lack of suitable guidelines for the growing number of people with multiple conditions.
Trish Greenhalgh, Professor of Primary Health Care and Dean for Research Impact, Queen Mary University of London, comments: “We want the Campaign for Real EBM to be a grass-roots movement, not a programme of work led by academic professors. One of the main drivers for a more ‘personalised’ version of EBM is patients, who have – rightly – demanded to be treated as individuals by caring doctors and nurses, not tyrannised by protocols. We need to develop tools and techniques for supporting conversations with patients about the best and most appropriate treatments, taking into account their priorities and preferences.”
Jigisha Patel, Medical Editor at BioMed Central, says: “In the early days of evidence-based medicine I witnessed the focus of patient care shift from the individual patient’s concerns to a box-ticking, target-hitting exercise. Patients expect to be informed about and take part in decision making about their care. BioMed Central supports the principles of evidence-based medicine and the right of patients to have access to this evidence through the publication of open access journals such as Systematic Reviews and Trials. We welcome the long overdue Campaign for Real EBM that aims to put the focus of patient care right back onto the concerns and wishes of the patient.”
Professor Trish Greenhalgh continues: “Currently, when someone visits their GP or a hospital doctor, quite a bit of the encounter will typically be taken up by the doctor working through a structured computer template that directs the questions to be asked, the parts of the body to be examined and the recommended medication. In the future, we want to be in a situation where doctor and patient collaboratively set the agenda and share decision-making in a more emergent way, guided and supported by tools that both reflect best research evidence - how the average patient is likely to respond to the different treatment options - and also prompt discussion about what matters to this patient.”
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