Professor Zena Moore: Evidence based clinical decisions

The concept of evidence is really important in clinical practice and for clinical decision-making and I do appreciate that there are challenges first of all in finding the evidence then interpreting it and then saying to yourself okay well what's the significance of this evidence for my practice and I think what I was trying to focus on was first of all the rationale the reason why we require evidence because there's the very good example of the logo of the Cochrane Collaboration which demonstrates to us the importance of synthesizing together what's the available evidence, looking at the strength of it, saying can we believe it and then what does it actually mean for patient care because that example was an ideal example of how the mortality rates of neonates could be reduced by 30 to 50 percent. But then when you come to the clinical practice setting there's always the challenge that when we look for evidence that sometimes the evidence isn't there and then people say okay well what do I do next but of course SACA told us the importance of looking at evidence as well as clinical experience and patients preferences and patients and people who are using the health service have a right that their voice is right at the central of all of the decision making about them and the thing about evidence is that it is always brought into the clinical setting and then it's our clinical expertise and our experience that tells us well how well does that evidence apply to the patient cohort that I have but sometimes things don't fit very well within the cohort that we have or maybe we don't understand exactly how we would apply the evidence and that's where the importance of networking and sharing our expertise among each other becomes really really central because we can learn so much from each other because others will have experiences to share that maybe we haven't experienced ourselves and maybe they have a longevity that we don't have and that they're able to say well you know in my experience it works better this way or that way. But then it leads us to thinking about well how should we share this information, who are we sharing the information with and how is it best to share it. And that brought me to thinking about well it really is about the message that we wanted to bring across and the audience that we're sharing it with. And because Ellie is so adamant and rightly so about the person, the patient being right at the centre, we need to remember that every single thing we do influences the patient and their families and their carers. So in its essence not having them in the education process is missing a really vital goal because they are the ones who will make the decision as to whether or not they would use the treatment. And we may have treatments that are absolutely amazing but are fundamentally unacceptable to people or is it that the people don't know enough about it to be making informed decisions about whether they should use it or not. So what I was trying to get at was trying to help people to understand that evidence plays an important role, that evidence is as important then when it's applied into practice, it's our clinical experience and patient preferences that help us to interpret that. But in order that people can understand and know what is the evidence and where is it and how do I interpret it, then there's a message that we have to give and there's lots of different ways that we could give the message and they will work differently in different circumstances. But fundamentally we need to understand the audience that we're targeting it at because it will depend on which particular people we're speaking to and what type of information needs that they have. But at the end of the day, we all, and that's what we hear all the time here at the conference, which is such a fantastic experience, is that we all want to drive forward better and improved outcomes for our patients and our users of the health service. And that together, collectively, we have one big voice that can achieve that. But once again, we must make sure that we keep an eye on the important elements, which is what is the evidence to support what we're doing? How do we apply that evidence into practice? And if it doesn't apply into practice, then we have consensus, but how is consensus brought about? And of course, clinical practice guidelines, providing they are peer-reviewed and systematically developed, are really useful areas. So what I was trying to do was to bring that all together in sort of one sandwich, as it were, to help people to understand that everything has an importance, but of course our old goal is to move into clinical practice and say, well, how well does that fit with our patient group? Thank you.