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How does evidence affect clinical decision-making?
  1. Paul Fontelo,
  2. Fang Liu,
  3. Raymonde C Uy
  1. National Library of Medicine, Bethesda, Maryland, USA
  1. Correspondence to Dr Paul Fontelo
    , National Library of Medicine, 8600 Rockville Pike, Bethesda, MD 20894, USA; fontelo{at}nlm.nih.gov

Extract

In 1998, the ‘Evidence Cart’ was introduced to provide decision support tools at the point of care. A recent study showed that a majority of doctors who previously stated that evidence was not needed sought it nevertheless when it was easily available. In this study, invited clinicians were asked to rate the usefulness of evidence provided as abstracts and ‘the bottom-line’ (TBL) summaries using a modified version of a web app for searching PubMed and then specify reasons how it might affect their clinical decision-making. The responses were captured in the server's log. 101 reviews were submitted with 22 reviews for abstracts and 79 for TBLs. The overall usefulness Likert score (1=least useful, 7=most useful) was 5.02±1.96 (4.77±2.11 for abstracts and 5.09±1.92 for TBL). The basis for scores was specified in only about half (53/101) of the reviews. The most frequent single reason (32%) was that it led to a new skill, diagnostic test, or treatment plan. Two or more reasons were given in 16 responses (30.2%). Two-thirds more responders used TBL summaries than abstracts, confirming further that clinicians prefer convenient, easy-to-read evidence at the point of care. This study seems to show similar results as the Evidence Cart study, on the usefulness of evidence in clinical decision-making.

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Extract

In 1998, the ‘Evidence Cart’ was introduced to provide decision support tools at the point of care. A recent study showed that a majority of doctors who previously stated that evidence was not needed sought it nevertheless when it was easily available. In this study, invited clinicians were asked to rate the usefulness of evidence provided as abstracts and ‘the bottom-line’ (TBL) summaries using a modified version of a web app for searching PubMed and then specify reasons how it might affect their clinical decision-making. The responses were captured in the server's log. 101 reviews were submitted with 22 reviews for abstracts and 79 for TBLs. The overall usefulness Likert score (1=least useful, 7=most useful) was 5.02±1.96 (4.77±2.11 for abstracts and 5.09±1.92 for TBL). The basis for scores was specified in only about half (53/101) of the reviews. The most frequent single reason (32%) was that it led to a new skill, diagnostic test, or treatment plan. Two or more reasons were given in 16 responses (30.2%). Two-thirds more responders used TBL summaries than abstracts, confirming further that clinicians prefer convenient, easy-to-read evidence at the point of care. This study seems to show similar results as the Evidence Cart study, on the usefulness of evidence in clinical decision-making.

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