Dear Andreas et al

Thanks you for this and for taking the time to respond; your pints are well taken. I didn’t want to swamp people with a long email describing what we are doing, but it may be worth clarifying further. This will be a project that uses patient vignettes and asks clinicians responsible for thrombolysis decisions to indicate whether they would or wouldn’t offer thrombolysis  based on a range of patients characteristics varied across the vignettes. The underlying methodological approach is a discrete choice experiment.

In addition to analysing the impact of patient characteristics on decision making, we are also keen to explore clinician variables that might contribute to decision making behaviour (such as experience with thrombolysis, seniority, training). This is therefore one variable (let’s call it confidence in the evidence) among several, so we are looking for a brief measure of that. We admit we cannot get into depth on the issue (which would require qualitative work or something quite different, as others have helpfully pointed out), but we do want to try and include it as a variable

Hope that helps clarify and thank you to those who have already responded.

Best wishes

Richard

From: Evidence based health (EBH) [mailto:[log in to unmask]] On Behalf Of Andreas Lundh
Sent: 27 January 2014 16:41
To: [log in to unmask]
Subject: Re: confidence in evidence

Dear Richard, I'm not a neurologist and I'm not familiar with the evidence. However, based on my knowledge I would be carefull with such a broad question. First, which outcomes? The evidence may be different (eg. Mortality vs neurological deficits).  You also need to consider that a decision depends on balance between benefit and harms. Lastly, that balance depends on your patient population and time of administration. You might consider making different patient scenarios. Just some thoughts.

Best

Andreas lundh

Den 27/01/2014 10.53 skrev "Richard Thomson" <[log in to unmask]>:

Dear all

We are undertaking a study of clinical decision making in thrombolysis in acute stroke, and seeking to understand (amongst other things) clinician-related factors that may influence decision making. There have been recent debates in the literature about the evidence. We want to get a measure from each clinician of their personal view on the strength of the evidence, but haven’t been able to find a published measure that we could use. We are thinking of something like a Likert scale with a question such as “How strong do you think the evidence is for the effectiveness of thrombolysis in improving outcome in acute ischaemic stroke”, but before taking this route, is anyone aware of any study that has used a question to assess perceptions of strength of evidence for a specific intervention that we could adopt/adapt?

Many thanks in advance

Best wishes
Richard

Richard Thomson
Professor of Epidemiology and Public Health

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