Summary
Background: A significant challenge associated with practicing evidence-based medicine is to
provide physicians with relevant clinical information when it is needed. At the same
time it appears that the notion of relevance is subjective and its perception is affected
by a number of contextual factors.
Objectives: To assess to what extent physi -cians agree on the relevance of evidence in the form
of systematic reviews for a common set of patient cases, and to identify possible
contextual factors that influence their perception of relevance.
Methods: A web-based survey was used where pediatric emergency physicians from multiple academic
centers across Canada were asked to evaluate the relevance of systematic reviews retrieved
automatically for 14 written case vignettes (paper patients). The vignettes were derived
from prospective data describing pediatric patients with asthma exacerbations presenting
at the emer gency department. To limit the cognitive burden on respondents, the number
of reviews associated with each vignette was limited to three.
Results: Twenty-two academic emergency physicians with varying years of clinical practice
completed the survey. There was no consensus in their evaluation of relevance of the
retrieved reviews and physicians’ assessments ranged from very relevant to irrelevant
evidence, with the majority of evaluations being somewhere in the middle. This indicates
that the study participants did not share a notion of relevance uniformly. Further
analysis of commentaries provided by the physicians allowed identifying three possible
contextual factors: expected speci ficity of evidence (acute vs chronic condition),
the terminology used in the systematic reviews, and the micro environment of clinical
setting.
Conclusions: There is no consensus among physicians with regards to what constitutes relevant
clinical evidence for a given patient case. Subsequently, this finding suggests that
evidence retrieval systems should allow for deep customization with regards to physi
-cian’s preferences and contextual factors, including differences in the micro environment
of each clinical setting.
Keywords
Evidence-based medicine - systematic review - information storage and retrieval -
evaluation study - pediatric asthma
