All of us are bombarded by treatment claims. These reach us through the media, from people selling treatments, from academics, from health professionals, and from relatives, friends and people we happen to bump into.
How should people making health choices assess the trustworthiness of such claimed effects of treatments? In particular, how should research evidence play into our assessment of these treatment claims – whether for treatments for something as trivial as a cold, or as life-threatening as cancer, or anything in between? Whatever the issue, those making treatment choices have the greatest vested interest in knowing how to go about assessing claims about the effects of treatments because it is they who stand to lose or benefit from the choices they make.
Not all treatment claims are equal
We should assume that everyone who initiates claims about the effects of treatments – or the relative merits and disadvantages of alternative treatments – is influenced by considerations other than trustworthy research evidence. Bias, financial conflicts and errors of omission are rife.
Most of us would want to take account of trustworthy research evidence, but what is ‘trustworthy evidence’? And how can people recognize it when they see it?
Addressing this challenge is the rationale for promoting informed healthcare choices as part of general knowledge. People need help to assess claims about the effects of treatments.
A collaboration to promote informed critical thinking about treatment claims
The Informed Health Choices project, working with the James Lind Initiative, is tackling this challenge. Taking as its starting point the book Testing Treatments (now translated into over a dozen languages), the project began by identifying 32 Key Concepts that people need to understand when assessing treatment claims. A bank of multiple choice questions to test people’s understanding of these Key Concepts has been created and is currently undergoing rigorous evaluation in several countries, including the UK. Based on a subset of the Key Concepts, learning materials (a comic book, a teachers’ guide, games, and podcasts) have been developed initially for Ugandan primary school children and their parents. The learning materials have been piloted and user tested in Uganda, Kenya, Rwanda and Norway. Importantly, the effects of these learning resources are now being assessed using randomized trials in Uganda, and further trials using similar materials are being planned in Australia.
What works best in teaching people how to assess treatment claims?
There are plenty of learning and teaching resources designed to improve lay understanding of research to test the effects of treatments. However, very few of these have been assessed using controlled trials to find out whether these resources have intended effects on knowledge, attitudes or behavior.
People promoting the principle of using trustworthy evidence to guide treatment choices should not acquiesce in the lack of evidence about the effects of these learning and teaching resources. The Fair Comparisons Network has been established as a forum for people interested in improving and evaluating learning and teaching resources.
Authors: Iain Chalmers, Paul Glasziou, Douglas Badenoch, Patricia Atkinson, Astrid Austvoll-Dahlgren and Andy Oxman