Question 8: Does it refer to areas of uncertainty?
What the question is about and why it is important
A good quality publication will include a reference to ‘grey’ areas where there is uncertainty about the most effective treatment. This uncertainty may be because:
no evidence about effective treatment choices exists
the existing evidence is contradictory
there is uncertainty as to who is most likely to benefit or be at risk from the treatment choice.
A good quality publication will highlight the fact that the choice of the most suitable treatment may not be clear-cut and that it may not be possible to predict the most likely outcome for you.
Rating the question
Your judgement will be very important for rating this question.
Guidelines for rating the question:
5: Yes - the publication includes a clear reference to any uncertainty regarding treatment choices: this may be linked to each treatment choice or may be covered in a more general discussion or summary of the choices mentioned in the publication.
2 - 4: Partially - uncertainty is mentioned but the information is unclear or incomplete.
1: No - no uncertainty about treatment choices is mentioned.
The question cannot be used to assess whether all aspects of uncertainty regarding a treatment choice or choices have been covered by the publication (as this would involve checking against other sources).
Examples
5 rating:
‘A minority of women will experience side-effects, but it is not always possible to know who these women will be until after treatment has been started.’
‘Doctors may give you vague answers to your questions, or may not be able to answer them all. Different doctors may give you different advice. You may be able to find out about the overall success rate of a treatment but doctors may not be able to tell you whether the treatment will definitely work for you. Some people find dealing with this uncertainty difficult. You may find it helpful to discuss your concerns with family or friends or someone from a support group.’
1 rating:
A webpage describes a single treatment for a skin condition. The page is written by a doctor and is found in the section on treatments on a national self-help organisation's website. The sources of evidence quoted are the scientist who developed and sells the treatment and the case of one of the doctor’s patients who has experienced a ‘miraculous’ cure. The only reference to other treatment choices is the statement that ‘all other treatments for the condition are associated with unacceptable side-effects’ and the possibility of ‘permanent disfigurement’ if no treatment is used. The patient’s search for a cure is described as ‘torture’ that led him to try other treatments that left him ‘scarred’ and ‘suicidal’. The treatment is said to produce ‘stunning and permanent results after a few applications with no risks or side-effects’. The author recommends the treatment as ‘suitable for anyone’ and ‘bringing hope to all those who have despaired of finding relief from this devastating and unsightly condition’.