FINDINGS FROM A SYSTEMATIC REVIEW OF ALTERNATE STRATEGIES FOR COMMUNICATING THE UNCERTAINTY OF MEDICAL EVIDENCE

Purpose:   Organizations that synthesize and disseminate medical evidence play an important role in helping clinicians and patients understand and use the information they need to make informed decisions. However, little is known about the most effective strategies to communicate medical uncertainty (e.g., around prevention or treatment choices). To evaluate the comparative effectiveness of alternate strategies to communicate the uncertainty related to medical evidence to clinicians and patients, we conducted a systematic review of the literature.

Methods: In accordance with Evidence-Based Practice Center standards, we developed and followed a standard protocol for our review. We searched MEDLINE® (January 1, 1966 to March 15, 2013), the Cochrane Library, Cochrane Central Trials Registry, and PsychInfo, using a combination of medical subject headings and keywords to identify articles on the uncertainty around communicating the strength of evidence, the magnitude of net benefit, and key subdomains (risk of bias, consistency, directness, and applicability). Two reviewers independently reviewed titles, abstracts, and full-text articles for inclusion. One reviewer abstracted article information into detailed evidence tables; a second confirmed accuracy. Two reviewers independently graded study quality using pre-specified criteria.

Results: We identified 9 relevant studies that met inclusion criteria. Studies that examined communicating the uncertainty about both the strength of a medical recommendation and its precision were small and produced mixed results. A single large well-executed population-based study demonstrated that both specific factual and concrete statements (e.g. “It takes time to establish the safety”) and advice (“Ask for the drug that….”) can help patients choose treatments with the least uncertainty, the most direct evidence of benefit, and the highest likelihood of net benefit. Another large population-based study suggested that altering the amount of benefit and harm information communicated to patients affects their choices for testing. No studies examined communication strategies for discussing the uncertainty of risk of bias, consistency, strength of evidence, or applicability.

Conclusions: A paucity of research exists on how best to communicate the uncertainty of medical evidence to different audience segments.  However, a limited number of studies are beginning to explore various approaches to addressing this communication challenge.  Our review provides an important first look at the impact of communicating the uncertainty in medical evidence and provides an agenda for future research.