ContextThe quality of consumer health information on the World Wide Web is
an important issue for medicine, but to date no systematic and comprehensive
synthesis of the methods and evidence has been performed.ObjectivesTo establish a methodological framework on how quality on the Web is
evaluated in practice, to determine the heterogeneity of the results and conclusions,
and to compare the methodological rigor of these studies, to determine to
what extent the conclusions depend on the methodology used, and to suggest
future directions for research.Data SourcesWe searched MEDLINE and PREMEDLINE (1966 through September 2001), Science
Citation Index (1997 through September 2001), Social Sciences Citation Index
(1997 through September 2001), Arts and Humanities Citation Index (1997 through
September 2001), LISA (1969 through July 2001), CINAHL (1982 through July
2001), PsychINFO (1988 through September 2001), EMBASE (1988 through June
2001), and SIGLE (1980 through June 2001). We also conducted hand searches,
general Internet searches, and a personal bibliographic database search.Study SelectionWe included published and unpublished empirical studies in any language
in which investigators searched the Web systematically for specific health
information, evaluated the quality of Web sites or pages, and reported quantitative
results. We screened 7830 citations and retrieved 170 potentially eligible
full articles. A total of 79 distinct studies met the inclusion criteria,
evaluating 5941 health Web sites and 1329 Web pages, and reporting 408 evaluation
results for 86 different quality criteria.Data ExtractionTwo reviewers independently extracted study characteristics, medical
domains, search strategies used, methods and criteria of quality assessment,
results (percentage of sites or pages rated as inadequate pertaining to a
quality criterion), and quality and rigor of study methods and reporting.Data SynthesisMost frequently used quality criteria used include accuracy, completeness,
readability, design, disclosures, and references provided. Fifty-five studies
(70%) concluded that quality is a problem on the Web, 17 (22%) remained neutral,
and 7 studies (9%) came to a positive conclusion. Positive studies scored
significantly lower in search (P = .02) and evaluation
(P = .04) methods.ConclusionsDue to differences in study methods and rigor, quality criteria, study
population, and topic chosen, study results and conclusions on health-related
Web sites vary widely. Operational definitions of quality criteria are needed.

/pdf/empirical-studies-assessing-the-quality-of-health-2zwfbp74fk.pdf

Empirical Studies Assessing the Quality of Health Information for Consumers on the World Wide Web: A Systematic Review

Objective To develop a set of quality criteria for patient decision support technologies (decision aids).

Design and setting Two stage web based Delphi process using online rating process to enable international collaboration.

Participants Individuals from four stakeholder groups (researchers, practitioners, patients, policy makers) representing 14 countries reviewed evidence summaries and rated the importance of 80 criteria in 12 quality domains ona1to9 scale. Second round participants received feedback from the first round and repeated their assessment of the 80 criteria plus three new ones.

Main outcome measure Aggregate ratings for each criterion calculated using medians weighted to compensate for different numbers in stakeholder groups; criteria rated between 7 and 9 were retained.

Results 212 nominated people were invited to participate. Of those invited, 122 participated in the first round (77 researchers, 21 patients, 10 practitioners, 14 policy makers); 104/122 (85%) participated in the second round. 74 of 83 criteria were retained in the following domains: systematic development process (9/9 criteria); providing information about options (13/13); presenting probabilities (11/13); clarifying and expressing values (3/3); using patient stories (2/5); guiding/coaching (3/5); disclosing conflicts of interest (5/5); providing internet access (6/6); balanced presentation of options (3/3); using plain language (4/6); basing information on up to date evidence (7/7); and establishing effectiveness (8/8).

Conclusions Criteria were given the highest ratings where evidence existed, and these were retained. Gaps in research were highlighted. Developers, users, and purchasers of patient decision aids now have a checklist for appraising quality. An instrument for measuring quality of decision aids is being developed.

https://www.bmj.com/content/bmj/333/7565/417.full.pdf

Developing a quality criteria framework for patient decision aids: online international Delphi consensus process

An integrative model of shared decision making in medical encounters

The fourth edition of the European guidelines for quality assurance in breast cancer screening and diagnosis was published by the European Commission in 2006. The present supplements to the fourth edition have been produced by the same groups of experts originally established under the Europe Against Cancer programme that have developed and updated the guidelines since the early 1990s. Over the years, the scope and the depth of the multidisciplinary guidelines have expanded, and recommendations and protocols have been updated to keep pace with developments in the field. The present supplements lay a cornerstone for a new, completely revised fifth edition of the guidelines

/pdf/european-guidelines-for-quality-assurance-in-breast-cancer-34igkumbby.pdf

European guidelines for quality assurance in breast cancer screening and diagnosis

Problems may arise when healthcare providers focus on managing diseases rather than on people and their health problems. Patient-centred approaches to care delivery in the patient encounter are increasingly advocated by consumers and clinicians and incorporated into training for healthcare providers. The authors updated a 2001 systematic review of the effects of these training interventions for healthcare providers that aim to promote patient-centred care in clinical consultations.
They found 29 new randomized trials (up to June 2010), bringing the total of studies included in the review to 43. In most of the studies, training interventions were directed at primary care physicians (general practitioners, internists, paediatricians or family doctors) or nurses practising in community or hospital outpatient settings. Some studies trained specialists. Patients were predominantly adults with general medical problems, though two studies included children with asthma.
These studies showed that training providers to improve their ability to share control with patients about topics and decisions addressed in consultations are largely successful in teaching providers new skills. Short-term training (less than 10 hours) is as successful in this regard as longer training. Results are mixed about whether patients are more satisfied when providers practice these skills. The impact on general health is also mixed, although the limited data that could be pooled showed small positive effects on health status. Patients' specific health behaviours show improvement in the small number of studies where interventions use provider training combined with condition-specific educational materials and/or training for patients, such as teaching question-asking during the consultation or medication-taking after the consultation. However, the number of studies is too small to determine which elements of these multi-faceted studies are essential in helping patients change their healthcare behaviours.

Interventions for providers to promote a patient‐centred approach in clinical consultations

Informing patients : an assessment of the quality of patient information materials

EDITOR—It was encouraging to see all the research papers on patient involvement in healthcare decision making in the issue of the BMJ on 18 September devoted to patient partnership. Research findings in this area go some way to filling the enormous gap in evidence that has existed for too long. There are publications that offer guidance on how to involve patients and the public, but these give practical advice and do …

/pdf/evidence-produced-in-evidence-based-medicine-needs-to-be-2pxv0manho.pdf

Evidence produced in evidence based medicine needs to be relevant.

In the latest of a monthly series in which patients and carers set learning points for readers, David Gilbert urges healthcare staff to think again about their role in improving clinical outcomes. For more information about the series, contact Rosamund Snow, patient editor, rsnow@bmj.com.

https://www.bmj.com/content/bmj/350/bmj.h1312.full.pdf

Car parking is a clinical quality issue

When you are in mental and emotional distress, part of the agony is because the mind cannot make sense of what is happening inside or outside.1 In this situation I have wanted a diagnosis to help explain what I am going through and to give a semblance of choice and control. If what I am feeling is something others regard as real, maybe it becomes more amenable to being fixed. Diagnosis is a key that might unlock the prison cell of suffering.

On the other hand, I have also hated being given a diagnosis. Questions such as whether I’m “really” depressed ignore my wider unhappiness and what matters in my life. Diagnostic labels imprison me as a passive patient rather than consider me as a person.

So, does Google’s offer of the PHQ-9 test help to unlock or lock the prison cell? This diagnostic tool focuses on physiological and biomedical symptoms. It puts firm emphasis on dysfunction and frames distress from the outset as an illness. “Significant” scores position your problems as being amenable to doctors’ treatment. Maybe that’s fair enough, but let’s look at context.

The underpinning …

Patient Commentary: Online screening for depression-old (paternalistic) wine in new (digital) bottles.

https://www.bmj.com/content/bmj/297/6646/489.3.full.pdf

Points: ABC of Eyes: Cataracts

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