The impact of context on evidence utilization: A framework for expert groups developing health policy recommendations
The impact of context on evidence utilization: A framework for expert groups developing health policy recommendations
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DOI：
10.1016/j.socscimed.2006.04.020
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发表时间：
2006-10-01
影响因子：
5.4
通讯作者：
Black, Nick A.
中科院分区：
文献类型：
--
作者：
Dobrow, Mark J.;Goel, Vivek;Black, Nick A.
相同的证据在不同的决策环境中是否应该导致相同的决策结果？为了提高对这一问题的理解，本研究考虑了背景如何影响卫生政策建议制定中的证据利用。我们使用嵌入式多案例研究设计来研究四个专家组如何制定加拿大安大略省乳腺癌、宫颈癌、结直肠癌和前列腺癌筛查的政策建议。我们采访了专家组成员，分析了会议议程/会议纪要、中期/最终报告以及其他与案件相关的文件。我们的分析揭示了不同的政策目标；使用、忽视或过度考虑三个关键决策支持工具；专家组成员使用不同决策支持工具的技能/能力各不相同；效果调节剂、资源限制和政治利益的不同影响；虽然需要做更多的工作来确定这些发现是否可以推广到癌症筛查政策之外，但我们认为循证政策的核心挑战不是开发国际证据，而是开发更系统、严格和全球性的方法来识别、解释和应用不同决策环境中的证据。我们的分析表明，证据的识别必须区分不同的政策目标，以便将广泛的证据概念化与适当的政策问题联系起来。对证据的解释必须承认不同政策目标的证据性质不同，平衡现有对证据质量的重视与评估证据普遍性的更复杂的方法。证据的应用还必须承认不同的政策目标，适当采用对证据的性质和所涉及的背景敏感的基于规则的评分方案和基于协议的共识方法。 (c) 2006 Elsevier Ltd. 保留所有权利。
Should the same evidence lead to the same decision outcomes in different decision-making contexts? In order to improve comprehension of this issue, this study considers how context influences evidence utilization in the development of health policy recommendations. We used an embedded multiple case study design to study how four expert groups formulated policy recommendations for breast, cervical, colorectal, and prostate cancer screening in Ontario, Canada. We interviewed expert group members and analysed meeting agendas/minutes, interim/final reports and other case-related documents.Our analyses revealed varying policy objectives; the use, neglect, or overextended consideration of three key decision support tools; the varying skills/abilities of expert group members in using different decision support tools; the varying impact of effect modifiers, resource constraints and political interests; and the differing development/consideration of context-specific evidence to address uncertainty in the external decision-making context.While more work is needed to determine if these findings are generalizable beyond cancer screening policy, we believe the central challenge for evidence-based policy is not to develop international evidence, but rather to develop more systematic, rigorous, and global methods for identifying, interpreting, and applying evidence in different decision-making contexts. Our analyses suggest that identification of evidence must distinguish between different policy objectives in order to link a broad conceptualization of evidence to appropriate policy questions. Interpretation of evidence must acknowledge the varying nature of evidence for different policy objectives, balancing existing emphasis on evidentiary quality with more sophisticated methods for assessing the generalizability of evidence. The application of evidence must also acknowledge different policy objectives, appropriately employing rule-based grading schemes and agreement-based consensus methods that are sensitive to the nature of the evidence and contexts involved. (c) 2006 Elsevier Ltd. All rights reserved.