Increased Public Understanding of Evidence Can Improve Healthcare Decision Making

Policy makers and medical practitioners traditionally believe that medical evidence plays the most important role in improving health outcomes and lowering costs. But a new study, published in Health Affairs, found that public understanding of the role of evidence-based care is equally important.

Public deliberation means calling upon a group of diverse backgrounds to consider ethical or values-based dilemmas and weigh alternative views. Kristin L. Carman, PhD, vice president of the Health and Social Development Program at the American Institutes for Research, along with her fellow researchers, obtained informed public views on the role of evidence in healthcare decisions. They found that personal choice and clinical judgment could trump evidence. It was also a strong consensus that the public viewed doctors as central figures in discussing evidence with patients.

Overall, the study concluded that increased public understanding of evidence can play an important role in advancing evidence-based care.

Study Method and Findings

The Community Forum Deliberative Methods Demonstration project employed randomly selected socio-demographically diverse 907 participants through 76 deliberative groups from August to November 2012.

During deliberations the participants’ consideration of evidence increased. Initially, participants often equated evidence with experience, such as a doctor’s experience and clinical judgment, personal experiences, and common sense, but as deliberations progressed, they started using more specific terms such as success rates, clinical results, and test results.

In general, more than 90% of the participants said that evidence is valuable and important in making informed care decisions. But they also emphasized that evidence of what works for most people may not apply to individual patients. Evidence was also viewed as imperfect—meaning changing over time—often based on studies excluding specific subpopulations defined by age or ethnicity, and lacking clarity.

Study groups expected clinicians to be aware of and generally follow evidence-based guidelines from professional medical societies but every once in a while, be flexible enough to depart from guidelines or evidence as needed for individual situations.

Participants stressed on the need for patients to educate themselves and ask questions of doctors. But it was found through the deliberations that there wasn't enough education and transparency about evidence to help inform decisions. Because patients do not have adequate access to information about evidence, the public is not relevantly informed.

Deliberation, Facts, and Interactive Debates

The public support for efforts to educate the public and translate medical evidence for consumers to inform their decision making is ever-increasing. But efforts to address cost factors and potential trade-offs for both individuals and society are still significantly limited.

The authors stress on the importance of deliberation. It is an important and underused mechanism for consumer and public engagement. If adopted more universally, the tool can help in developing and implementing policies and programs that influence research, treatment options, and health care delivery.

“Our findings also demonstrate how the public, including traditionally underserved populations, can provide informed views to policy makers on complex issues related to the use and role of evidence in medical decisions, including the development of clinical guidelines, coverage decisions by employers or public agencies, and other resource allocation decisions,” the authors concluded.