Level of scientific evidence needed to make an informed health decision among researchers, healthcare workers and consumers: a cross-sectional study
2Department of Psychology, Faculty of Humanities and Social Sciences, University of Split, Split, Croatia, Croatia
Background: The hierarchy of evidence is considered as widely known to evidence-based medicine experts. However, it remains unknown how nonexperts understand it and how they use it in decision-making.
Objectives: To assess what level of evidence is needed for different stakeholders in the healthcare system to make treatment effectiveness decisions.
Methods: A quantitative cross-sectional study was conducted from November 2021 to February 2022 using an online survey. The participants were researchers, healthcare workers and consumers from Croatia. The survey had six scenarios about the same medical treatment presented within different study designs and in random order. Participants were asked to assess whether the descriptions presented a sufficient level of evidence to conclude that the treatment was effective.
Results: A total of 584 participants were eligible for inclusion (97 researchers, 201 healthcare workers and 286 consumers). Participants were mainly women (N=434 (74%), median age 43.5, interquartile range 33-52). For researchers, as the number of participants and degree of variable control in the study design increased, the perceived level of sufficient evidence also increased significantly. Among consumers, no significant differences were observed in scores between cross-sectional study, cohort study, randomised controlled trial and systematic review. Healthcare workers’ assessments were significantly lower for case studies and case series compared to other study designs (Figure 1).
Conclusions: Consumers and healthcare workers did not increase their certainty about the effectiveness of the therapy when higher-level study designs were presented compared to lower-level study designs. There is a need to implement educational courses on basic research methodology in lower levels of education and as part of the Continuing Medical Education for all stakeholders in the healthcare system.
Patient, public and/or healthcare consumer involvement: Healthcare consumers were involved in the study as participants. Educating patients and other stakeholders in the healthcare system would lead to more informed decision-making.