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- Howick, Jeremy, et al.
(författare)
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Effects of empathic and positive communication in healthcare consultations: a systematic review and meta-analysis
- 2018
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Ingår i: Journal of the Royal Society of Medicine. - : Sage Publications. - 0141-0768 .- 1758-1095. ; 111:7, s. 240-252
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundPractitioners who enhance how they express empathy and create positive expectations of benefit could improve patient outcomes. However, the evidence in this area has not been recently synthesised.ObjectiveTo estimate the effects of empathy and expectations interventions for any clinical condition.DesignSystematic review and meta-analysis of randomised trials.Data sourceSix databases from inception to August 2017.Study selectionRandomised trials of empathy or expectations interventions in any clinical setting with patients aged 12 years or older.Review methodsTwo reviewers independently screened citations, extracted data, assessed risk of bias and graded quality of evidence using GRADE. Random effects model was used for meta-analysis.ResultsWe identified 28 eligible (n = 6017). In seven trials, empathic consultations improved pain, anxiety and satisfaction by a small amount (standardised mean difference −0.18 [95% confidence interval −0.32 to −0.03]). Twenty-two trials tested the effects of positive expectations. Eighteen of these (n = 2014) reported psychological outcomes (mostly pain) and showed a modest benefit (standardised mean difference −0.43 [95% confidence interval −0.65 to −0.21]); 11 (n = 1790) reported physical outcomes (including bronchial function/ length of hospital stay) and showed a small benefit (standardised mean difference −0.18 [95% confidence interval −0.32 to −0.05]). Within 11 trials (n = 2706) assessing harms, there was no evidence of adverse effects (odds ratio 1.04; 95% confidence interval 0.67 to 1.63). The risk of bias was low. The main limitations were difficulties in blinding and high heterogeneity for some comparisons.ConclusionGreater practitioner empathy or communication of positive messages can have small patient benefits for a range of clinical conditions, especially pain.Protocol registrationCochrane Database of Systematic Reviews (protocol) DOI: 10.1002/14651858.CD011934.pub2.
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| 3. |
- Howick, Jeremy, et al.
(författare)
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In search of justification for the unpredictability paradox
- 2014
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Ingår i: Trials. - : BioMed Central. - 1745-6215. ; 15:480
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Tidskriftsartikel (refereegranskat)abstract
- A 2011 Cochrane Review found that adequately randomized trials sometimes revealed larger, sometimes smaller, and often similar effect sizes to inadequately randomized trials. However, they found no average statistically significant difference in effect sizes between the two study types. Yet instead of concluding that adequate randomization had no effect the review authors postulated the "unpredictability paradox", which states that randomized and non-randomized studies differ, but in an unpredictable direction. However, stipulating the unpredictability paradox is problematic for several reasons: 1) it makes the authors' conclusion that adequate randomization makes a difference unfalsifiable-if it turned out that adequately randomized trials had significantly different average results from inadequately randomized trials the authors could have pooled the results and concluded that adequate randomization protected against bias; 2) it leaves other authors of reviews with similar results confused about whether or not to pool results (and hence which conclusions to draw); 3) it discourages researchers from investigating the conditions under which adequate randomization over- or under-exaggerates apparent treatment benefits; and 4) it could obscure the relative importance of allocation concealment and blinding which may be more important than adequate randomization.
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| 4. |
- Howick, Jeremy, et al.
(författare)
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Philosophy of Evidence-Based Medicine
- 2015
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Ingår i: Oxford Bibliographies in Philosophy. - : Oxford University Press.
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Bokkapitel (refereegranskat)abstract
- Since its introduction just over two decades ago, evidence-based medicine (EBM) has come to dominate medical practice, teaching, and policy. There are a growing number of textbooks, journals, and websites dedicated to EBM research, teaching, and evidence dissemination. EBM was most recently defined as a method that integrates best research evidence with clinical expertise and patient values and circumstances in the treatment of patients. There have been debates throughout the early 21st century about what counts as good research evidence between EBM proponents and philosophical critics and even within the EBM community itself. Similar controversy arises about the relative worth of patient values and clinical expertise (and how these can be integrated). EBM has also evolved in ways that have come under scrutiny. Specifically, policymakers have used EBM research methodology to increase the relative importance of clinical guidelines that some clinicians have argued are tyrannical. Philosophers have addressed all of these controversies, and with very few exceptions have been critical of EBM. In addition most philosophical attention has been on the epistemic role of Randomization and evidence hierarchies, with relatively little attention being paid to the role of Diagnosis, expertise, patient values, and Systematic Reviews within EBM.
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| 5. |
- Howick, Jeremy, et al.
(författare)
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Positive "framing" as a powerful medication for pain : A meta-analysis of randomized trials
- 2016
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Ingår i: European Journal of Integrative Medicine. - : Elsevier. - 1876-3820 .- 1876-3839. ; 8, s. 57-59
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: A growing body of evidence suggests that positive framing–inducing positive expectations about the outcome of treatments can reduce pain symptoms. However there is no pooled estimate of the effect size of positive framing for treating pain. Such an estimate is useful to understand the extent to which positive expectations can enhance usual care.Methods: We extracted data from a recent systematic review of interventions that modified all "context factors" (including but not limited to) inducing positive expectations) in adults suffering from pain. The systematic review concluded that positive expectations were effective, but did not pool the results so no effect size was provided. Two authors independently extracted data from the studies and conducted the analysis. Our primary outcome was patient self-reported pain.Results: 10 randomized trials were eligible for meta-analysis. In the trials with continuous outcomes the standardized effect size was −0.39 (95% confidence interval −0.68 to −0.10, p = 0.009, I2 = 79%), suggesting reduced pain on average in groups in which positive expectations were induced. The effect size was similar in magnitude but was not statistically significant when we excluded studies deemed to have a high risk of bias (standard effect size −0.31, 95% CI −0.65 to 0.02, p = 0.07, I2 = 77%).Conclusion: The effect of inducing positive expectations is comparable to the effects of some pharmacological drugs. However many of the studies had a high risk of bias, and heterogeneity was significant. Future research is warranted including investigating ways to implement this evidence into patient care in an ethical way.
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| 6. |
- Howick, Jeremy, et al.
(författare)
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Randomized trials and observational studies : the current philosophical controversy
- 2016
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Ingår i: Handbook of the Philosophy of Medicine. - Dordrecht : Springer. - 9789401786874 ; , s. 873-886
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Bokkapitel (refereegranskat)abstract
- The supposed superiority of randomized over non-randomized studies is used to justify claims about therapeutic effectiveness of medical interventions and also inclusion criteria for many systematic reviews of therapeutic interventions. However, the view that randomized trials provide better evidence has been challenged by philosophers of science. In addition, empirical evidence for average differences between randomized trials and observational studies (which we would expect if one method were superior) has proven difficult to find. This chapter reviews the controversy surrounding the relative merits of randomized trials and observational studies. It is concluded that while (well-conducted) observational can often provide the same level of evidential support as randomized trials, merits of (well-conducted) randomized trials warrant claims about their superiority, especially where results from the two methods are contradictory.
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| 7. |
- Mebius, Alexander
(författare)
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A weakened mechanism is still a mechanism: On the causal role of absences in mechanistic explanation
- 2014
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Ingår i: Studies in History and Philosophy of Science Part C. - : Elsevier BV. - 1369-8486 .- 1879-2499. ; 45, s. 43-48
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Tidskriftsartikel (refereegranskat)abstract
- Much contemporary debate on the nature of mechanisms centers on the issue of modulating negative causes. One type of negative causability, which I refer to as “causation by absence,” appears difficult to incorporate into modern accounts of mechanistic explanation. This paper argues that a recent attempt to resolve this problem, proposed by Benjamin Barros, requires improvement as it overlooks the fact that not all absences qualify as sources of mechanism failure. I suggest that there are a number of additional types of effects caused by absences that need to be incorporated to account for the diversity of causal connections in the biological sciences. Furthermore, it is argued that recognizing natural variability in mechanisms, such as attenuation, leads to some interesting line-drawing issues for contemporary philosophy of mechanisms.
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| 8. |
- Mebius, Alexander
(författare)
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Against ‘instantaneous’ expertise
- 2022
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Ingår i: Philosophy Ethics and Humanities in Medicine. - : Springer Nature. - 1747-5341. ; 17:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Healthcare is predicated on the use of biotechnology and medical technology, both of which are indispensable in diagnosis, treatment, and most aspects of patient care. It is therefore imperative that justifications for use of new technologies are appropriate, with the technologies working as advertised. In this paper, I consider philosophical accounts of how such justifications are made.Methods: Critical philosophical reflection and analysis.Results: I propose that justification in many prominent accounts is based on the designer’s professional experienceand on expert testimony. I argue, however, that professional designers are not in a position to justify a new biotechnology or medical device if the justification is based on testimony or past experience of presumably similar technologies. I argue (1) that similarity judgments offered by instantaneous experts cannot be viewed as contributing (epistemically) to evidential justification of new and unproven technologies; and (2) that designers and manufacturers cannot endorse a technology’s effective function in a patient-care context until it has been successfully used in that context.Conclusion: I show that an expert’s past professional experiences can never predict or justify the impact of a novel technology on human health. This is because any new technology leads to the introduction of new mechanisms with unprecedented functions. The new technology therefore needs to be studied in situ and justified as a newly created mechanism within the relevant healthcare setting. Ultimately, justifications of this type rely on the scientific community and society engaging in repeated experimentation and observation of the technology, and confirming its successful use.
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| 9. |
- Mebius, Alexander
(författare)
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Alex Broadbent: Philosophy of Medicine
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Ingår i: Journal for General Philosophy of Science, Zeitschrift für allgemeine Wissenschaftstheorie. - 0925-4560 .- 1572-8587.
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Recension (refereegranskat)
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