Deliberating the pros and cons of medical evidence to govern treatment decisions increases the public’s willingness to limit patient choices, especially when those choices can harm the individual or the larger community, according to an AIR study published in the April 2016 Health Affairs, titled, “Understanding an Informed Public’s Views on the Role of Medical Evidence in Making Health Care Decisions.”
While people overwhelmingly believe medical evidence is key to high-quality care, they struggle with understanding what constitutes clear medical evidence—often at first equating evidence with a doctor’s accumulated experience and clinical judgment rather than clinical research results. The public is also deeply skeptical of limiting patient choice and physician autonomy in individual cases regardless of the evidence, believing clinicians, as experts with specialized education and knowledge of the individual patient, should be free to depart from guidelines or evidence for individual situations.
However, when given the opportunity to learn about and discuss medical evidence through deliberation, their views can shift toward giving more weight to medical evidence and less to patient preferences. For example, when study participants learned about and discussed the threats of antibiotic resistance to individuals and the larger community when antibiotics are misused—to treat a viral infection like a cold, for instance—they were more willing to limit patient choice and physician autonomy.
Conducted as part of the Community Forum on Deliberative Methods Demonstration funded by the Agency for Healthcare Research and Quality, the AIR study used public deliberation—a unique way of convening diverse citizens to consider an ethical or values-based dilemma—to obtain informed public views on the role of medical evidence in treatment decisions. Unlike surveys and focus groups that measure the prevalence and range of opinions—or so-called top-of-mind views—public deliberation encourages people to become informed about a topic and consider alternative—often competing—perspectives. Principal Investigator Kristin Carman presented on the study at the Health Affairs briefing on Patients' and Consumers' Use of Evidence.
Earlier AIR research, as reported in a May 2015 Social Science & Medicine article, titled “Effectiveness of Public Deliberation Methods for Gathering Input on Issues in Healthcare: Results from a Randomized Trial,” found that deliberation effectively provides informed public views on complex health policy issues. Additionally, deliberation is an effective way to gather public input from diverse groups, including African Americans, Hispanics and people with less education as reported in a February 2015 Journal of Health Care for the Poor and Underserved article, titled “Deliberation: Obtaining Informed Input from a Diverse Public,”
Both studies indicate that public deliberation is an effective way for policymakers to both engage citizens in complicated health care issues and ‘see around the corners’ to better understand and anticipate how public attitudes might change as people learn more about specific issues and discuss them. An AIR fact sheet provides background about public deliberation and study findings.