Rosamund Snow

Six ‘biases’ against patients and carers in evidence-based medicine

BackgroundEvidence-based medicine (EBM) is maturing from its early focus on epidemiology to embrace a wider range of disciplines and methodologies. At the heart of EBM is the patient, whose informed choices have long been recognised as paramount. However, good evidence-based care is more than choices.DiscussionWe discuss six potential ‘biases’ in EBM that may inadvertently devalue the patient and carer agenda: limited patient input to research design, low status given to experience in the hierarchy of evidence, a tendency to conflate patient-centred consulting with use of decision tools; insufficient attention to power imbalances that suppress the patient’s voice, over-emphasis on the clinical consultation, and focus on people who seek and obtain care (rather than the hidden denominator of those that do not seek or cannot access care).SummaryTo reduce these ‘biases’, EBM should embrace patient involvement in research, make more systematic use of individual (‘personally significant’) evidence, take a more interdisciplinary and humanistic view of consultations, address unequal power dynamics in healthcare encounters, support patient communities, and address the inverse care law.

Setting research priorities for Type 1 diabetes.

Diabet. Med. 29, 1321–1326 (2012)

Understanding issues associated with attending a young adult diabetes clinic: a case study.

Diabet. Med. 29, 257–259 (2012)

Why the Assisted Dying Bill should become law in England and Wales

It’s the right thing to do, and most people want it

The power of symbolic capital in patient and public involvement in health research

Policy‐makers and health research funders increasingly require researchers to demonstrate that they have involved patients in the design and conduct of research. However, the extent to which patients and public have the power to get involved on an equal footing is dependent on their economic, cultural, social and symbolic capital.

Use of clinical targets in diabetes patient education: qualitative analysis of the expectations and impact of a structured self-management programme in Type 1 diabetes.

To explore the impact of education and target‐setting on the life stories of patients with diabetes up to 10 years after they had participated in the Dose Adjustment for Normal Eating programme (DAFNE).

Co-creating health: more than a dream

The slow march towards true partnership with patients, which The BMJ champions, is progressing

Frequency of reporting on patient and public involvement (PPI) in research studies published in a general medical journal: a descriptive study

Objectives While documented plans for patient and public involvement (PPI) in research are required in many grant applications, little is known about how frequently PPI occurs in practice. Low levels of reported PPI may mask actual activity due to limited PPI reporting requirements. This research analysed the frequency and types of reported PPI in the presence and absence of a journal requirement to include this information. Design and setting A before and after comparison of PPI reported in research papers published in The BMJ before and 1 year after the introduction of a journal policy requiring authors to report if and how they involved patients and the public within their papers. Results Between 1 June 2013 and 31 May 2014, The BMJ published 189 research papers and 1 (0.5%) reported PPI activity. From 1 June 2015 to 31 May 2016, following the introduction of the policy, The BMJ published 152 research papers of which 16 (11%) reported PPI activity. Patients contributed to grant applications in addition to designing studies through to coauthorship and participation in study dissemination. Patient contributors were often not fully acknowledged; 6 of 17 (35%) papers acknowledged their contributions and 2 (12%) included them as coauthors. Conclusions Infrequent reporting of PPI activity does not appear to be purely due to a failure of documentation. Reporting of PPI activity increased after the introduction of The BMJ’s policy, but activity both before and after was low and reporting was inconsistent in quality. Journals, funders and research institutions should collaborate to move us from the current situation where PPI is an optional extra to one where PPI is fully embedded in practice throughout the research process.

Logging The BMJ’s “patient journey”

Big changes, big challenges, much learning, and encouraging progress

Does hearing the patient perspective improve consultation skills in examinations? An exploratory randomized controlled trial in medical undergraduate education

Abstract Purpose: Medical education increasingly includes patient perspectives, but few studies look at the impact on students’ proficiency in standard examinations. We explored students’ exam performance after viewing video of patients’ experiences. Methods: Eighty-eight medical students were randomized to one of two e-learning modules. The experimental group saw video clips of patients describing their colposcopy, while the control group viewed a clinician describing the procedure. Students then completed a Multiple Choice Questionnaire (MCQ) and were assessed by a blinded clinical examiner in an Objective Structured Clinical Examination (OSCE) with a blinded simulated patient (SP). The SP scored students using the Doctors’ Interpersonal Skills Questionnaire (DISQ). Students rated the module’s effect on their skills and confidence. Regression analyses were used to compare the effect of the two modules on these outcomes, adjusting for gender and graduate entry. Results: The experimental group performed better in the OSCE than the control group (odds ratio 2.7 [95%CI 1.2–6.1]; p = 0.016). They also reported significantly more confidence in key areas, including comfort with patients’ emotions (odds ratio 6.4 [95%CI 2.7–14.9]; p < 0.0005). There were no other significant differences. Conclusion: Teaching that included recorded elements of real patient experience significantly improved students’ examination performance and confidence.