J Canc Educ DOI 10.1007/s13187-014-0631-0

Familiarity of Physicians, Translational Researchers, Nurses, and Other Health Professionals with Evidence-Based Medicine Terms and Resources Donatella Ugolini & Georgia Casanova & Marcello Ceppi & Francesca Mattei & Monica Neri

# Springer Science+Business Media New York 2014

Abstract Evidence-based medicine (EBM) is a central theme in health practice and training. The understanding of EBM technical terms and the familiarity with EBM resources were surveyed in four different health professional categories. A self-administered questionnaire on the familiarity with EBM terminology and resources was proposed to 218 health professionals (physicians, translational researchers, nurses, and others) working in the oncology field. Relationships between variable and familiarity were examined: Pearson χ2 or exact Fisher test was used for the categorical variables and one-way ANOVA for the continuous ones. The odds of familiarity for subjects, who had followed or not at least one EBM course, were estimated fitting a multiple logistic regression model adjusted for age, gender, and profession. All subjects completed the questionnaire. The majority of health personnel seemed to lack a sound knowledge of key EBM terms and sources. Physicians showed the highest knowledge of terms, nurses the lowest. Physicians also declared the largest D. Ugolini (*) : G. Casanova Department of Internal Medicine, University of Genoa, Genoa, Italy e-mail: [email protected] D. Ugolini Unit of Clinical Epidemiology, IRCCS Azienda Ospedaliera Universitaria San Martino-IST-Istituto Nazionale per la Ricerca sul Cancro, Largo R. Benzi, 10, 16132 Genoa, Italy G. Casanova “Vita e Salute” San Raffaele University, Milan, Italy M. Ceppi Unit of Biostatistics, IRCCS Azienda Ospedaliera Universitaria San Martino-IST-Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy F. Mattei : M. Neri Unit of Clinical and Molecular Epidemiology, IRCCS San Raffaele Pisana, Rome, Italy

familiarity with the widest variety of resources, followed by others and the researchers. The most popular resource was PLNG, the Italian Guideline System. People who attended at least one EBM course showed consistently higher percentages of knowledge, but the association was irrelevant for nurses. The main perceived barrier to implement EBM in practice was a lack of personal time. Familiarity of health professionals with EBM terminology and resources is still limited to the medical field and needs to be improved. Increasing education may be pivotal, even if different approaches should be developed for different professional categories. Keywords Attitude of health personnel . Evidence-based medicine . Health care surveys . Questionnaires . Education

Introduction The practice of evidence-based medicine (EBM) has been traditionally defined as combining the best medical research findings with clinical judgment, expertise, and experience. Sachet in 1996 defined EBM as “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. The practice of EBM means integrating individual clinical experience with the best available external clinical evidence from systematic research” [1]. Today, EBM is a central theme in health practice as well as in health care policy-making and training, at both undergraduate and postgraduate levels. In an online poll hosted by the British Medical Journal in January 2007, EBM ranked seventh, ahead of computer and medical imaging, among the 15 most important milestones that are shaping modern medicine [2]. As the EBM concept has evolved, other key factors affecting clinical decision-making have been identified. The clinical

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setting, state, and circumstances are viewed as playing a crucial role in decisions about patient care, along with the individual preferences and values of the patient [3]. EBM requires skills in finding and critically appraising medical literature, in order to get and apply the best evidence to clinical decision-making. These skills apply to four steps: problem definition, construction and conduction of an efficient search to locate the best evidence, critical estimate of the evidence, and consideration of that evidence and its implications in the context of patients’ circumstances and value. Locating the best research evidence from the medical literature and interpreting statistical data are critical parts of this complex process, together with interpreting statistical data [4]. The interest in EBM has been continuously increasing in the last decades. But very little is known about the health professionals’ actual attitudes towards EBM, the extent of their skills to access and interpret evidence, the barriers to moving from opinion-based to evidence-based practice, and the additional support necessary to incorporate EBM into everyday general practice. In addition, most of the published articles regard the knowledge of EBM terms and resources of physicians and, to a lesser extent, nurses [5–15], while studies on translational researchers or other professionals are not yet available worldwide. The present paper has three aims: to assess the familiarity with EBM resources in four different health professionals, to evaluate their capability to understand technical terms used in EBM, and to inspect what are the major barriers to practicing EBM.

Materials and Methods Design This study was a survey on health personnel working in the oncology field and attending lectures, using a selfadministered questionnaire on their familiarity and use of sources of evidence and their perceived understanding of EBM terminology, besides their attitudes and opinion toward EBM (not reported). Recruitment From November 2008 to October 2009, all health personnel attending lectures on EBM at the National Cancer Research Institute in Genoa (CME program) and at the University of Genoa (postgraduate School of Oncology, Health Technicians degree) were invited to complete the survey. All 218 approached workers filled the questionnaire (100 % response rate): 54 physicians, 56 translational researchers (mainly biologists), 65 nurses, and 43 other health professionals (including

laboratory technicians, physiotherapists, dieticians, etc.). Almost all recruited subjects were working in the oncology area. Procedure The questionnaires were administered prior to commencement of the EBM course. Completion of the questionnaire was voluntary, and no incentives were offered. Ethical approval for the study was not required. Questionnaire The questionnaire was designed to be short, simple, and easy to understand and interpret by study participants. A preliminary version, adapted from McColl et al. [16] with the addition of newly developed items, was pilot tested and reviewed for content validity by 12 health workers from the National Cancer Research Institute (Genoa) with different backgrounds. Based on their feedback, minor changes were made prior to its administration. The final questionnaire required about 10 min for completion and included the following: 1. Respondent demographics with personal and professional characteristics, including age 2. Previous participation to any course on EBM (yes or no) 3. Understanding of 16 methodological terms frequently used in EBM, self-evaluated with a four-point scale (“not well,” “a little,” “well,” “extremely well”). A binary response (“yes,” “no”) was adopted for statistical analysis after grouping “not well” with “a little” and “well” with “extremely well” 4. Familiarity with ten EBM resources, self-evaluated with a four-point scale. A binary response was adopted for statistical analysis, as above 5. A free text section to express their view on the main barriers to incorporating EBM in their general practice

Statistical Analysis After collecting all the completed questionnaires, the data was entered into a spreadsheet. Demographic and baseline characteristics were summarized using descriptive statistics. Specific relationships with the respondents’ profession were examined using the Pearson’s χ2 test for categorical variable or exact Fisher test when expected values were less than five, and oneway ANOVA was applied for continuous variables. The familiarity with EBM terminology and resources was explored in relation to the profession, through the application of the Pearson’s χ2 test. The odds for familiarity with EBM terminology and resources between subjects who followed or did not follow at least one EBM course were estimated fitting a multiple logistic regression model, adjusted for age, gender, and

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The most known terms were “mean/median,” followed by “meta-analysis,” “systematic review,” “confidence interval,” and “case-control study,” that were familiar for three quarters to half of the subjects and belonged to both areas (statistics and epidemiology). However, only less than half of nurses and others understood well the terms “mean/median,” and the three less known terms (one in six persons or less) were all included in the statistics field. The physicians, followed by the researchers, showed the highest familiarity with EBM-related terms, while the nurses showed the lowest. The percentage of participants who indicated that they understood terms well ranged from 100 % of the researchers for the terms “mean/ median” to 0 % of the nurses and the other professionals for less common statistical terms. Table 3 shows how knowledge of EBM-related terms varied with respect to having attended at least one course or not: there was a consistently higher percentage of knowledge among people who attended at least one course. ORs of understanding the terms according to previous participation in EBM courses was calculated for the whole sample, after adjusting for age, gender, and profession. A significant positive association with having attended an EBM course was shown for the terms “odds ratio” (OR=5.71, 95 % CI=2.10–15.56, p=0.001), “logistic regression” (OR=2.94, 95 % CI=1.06–8.09, p=0.037), and “Kaplan Meier analysis” (OR=7.18, 95 % CI=2.39–21.57, p0.05). Knowledge of EBM-Related Methodological Terms The participants’ self-assessed understanding of EBM-related terminology is reported in Table 2.

Table 1 Demographic characteristics of the survey respondents

Age

Gender Previously attended EBM Course Total

Physicians

Researchers

Nurses

Other health professionals

Total

n

%

n

%

n

%

n

%

n

%

≤34

3

5.6 %

4

7.1 %

25

38.5 %

8

18.6 %

40

18.3 %

35–44 45–54 55+ Mean±SD Female Male Yes No

20 37.0 14 25.9 17 31.5 48.0±9.0 38 70.4 16 29.6 13 24.1 41 75.9

46.5 % 32.6 % 2.3 %

96 44.0 52 23.9 30 13.8 42.6±9.3 141 64.7 77 35.3 36 16.5 182 83.5

54

% % % % % % %

24.8 %

P value from a ANOVA and b Pearson chi-square

28 50.0 % 12 21.4 % 12 21.4 % 45.5±8.6 30 53.6 % 26 46.% 10 17.9 % 46 82.1 %

28 43.1 % 12 18.5 % 0 0.0 % 36.5±7.2 47 72.3 % 18 27.7 % 7 10.8 % 58 89.2 %

20 14 1 41.3±7.6 26 17 6 37

60.5 39.5 14.0 86.0

56

65

43

19.7 %

25.7 %

29.8 %

% % % %

218

P value

% % % % % % %

100 %

Familiarity of physicians, translational researchers, nurses, and other health professionals with evidence-based medicine terms and resources.

Evidence-based medicine (EBM) is a central theme in health practice and training. The understanding of EBM technical terms and the familiarity with EB...
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