7.1 Consumer Survey Findings
7.1.1 Wave 2 Consumer Survey Findings
Although nearly 65 percent of respondents were aware of the concept of comparing treatment choices and 45 percent had heard of research that can help compare treatment options, only 11 percent indicated that they had heard of the research referred to "by a specific name." Of that group, only two respondents knew it as "comparative effectiveness research," and two respondents identified this research as "patient-centered outcomes research," "PCOR," or "shared decisionmaking."
When given a definition, 21 percent of respondents indicated that they were aware of research that can help compare treatment options. Respondents who were between 45 and 64 years old (compared to those 18 to 44 years old and 65 and older), Black (compared to White and other races), female, and not enrolled in Medicare or Medicaid (compared to enrollees) were statistically more likely to be aware of the concept of such research.
Print media, such as newspapers, journals, and magazines, served as the most common source of information on CER, followed by Web sites, television/radio, and health care providers. Of those learning about CER from their clinicians, 51 percent (21 respondents) indicated that their provider had initiated discussions about CER. Health care providers and Web sites were the most common preferred methods to obtain medical information.
Of consumers who indicated awareness of CER (unaided or aided) and/or awareness of the EHC Program, just over half currently use research to help make medical decisions; one-fifth have used it in the past. Respondents who were between 18 and 44 years old (compared to aged 45 and older respondents), Black (compared to White and other races), and female were statistically more likely to use such research. Medicare beneficiaries were statistically more likely than their non-Medicare enrollee counterparts to use CER; however, Medicaid beneficiaries were statistically less likely than non-enrollees to report use of CER.
Knowledge of AHRQ and the EHC Program was low among respondents. Only 11 percent of consumers had heard of AHRQ prior to the survey; likewise, seven percent had heard of the EHC Program. Three respondents had visited the EHC Program Web site. Similarly, knowledge and use of consumer summaries was low among consumers. Only 70 respondents were aware of consumer summaries; of that group, 26 had actually used them. Respondents who were 65 years and older (compared to aged 18 to 64), Black (compared to White and other races), and female were statistically more likely to be aware of consumer summaries. Medicare beneficiaries were statistically more likely than non-enrollees to be aware of consumer summaries. Similarly, Medicaid beneficiaries were statistically more likely than non-enrollees to indicate awareness of consumer summaries.
Respondents demonstrated a strong interest in using CER. A majority of respondents were interested in evaluating treatment options before making medical decisions (74 percent), while fewer were interested in learning more about evaluating treatment options for specific conditions (51 percent) and learning about the EHC Program (58 percent). Although interest in learning about CER was high, respondents' intention to use CER was comparatively low. Only 45 percent of respondents indicated that they intended to evaluate treatment options to prepare for a medical visit or make medical decisions. Respondents who were between 18 and 44 years old (compared to aged 45 and older respondents), Black (compared to White and other races), and female were statistically more likely to report an intention to use consumer summaries. Medicare beneficiaries were statistically less likely than their non-enrollee counterparts to report intention to use consumer summaries. However, Medicaid beneficiaries were statistically more likely than non-enrollees to indicate intention to use consumer summaries.
Of those who reported awareness of CER (unaided or aided), 11 percent indicated that, in the past six months, they had seen links to the EHC Program Web site or information comparing treatment options on a Web site. Of the 413 respondents who reported that they were a member of an organization that provides information about health care, 17 percent said the organization informed them about the EHC Program or about CER.
7.1.2 Longitudinal Consumer Survey Findings
The longitudinal analysis comparing wave 1 to wave 2 suggests increases in awareness of and interest in CER, AHRQ, and the EHC Program among consumers. Although changes in consumers' awareness of CER did not reach statistical significance, unaided awareness increased from 61 percent in wave 1 to 65 percent in wave 2, while aided awareness increased from 18 percent in wave 1 to 21 percent in wave 2. Furthermore, awareness of research on the evaluation of treatment options for specific medical conditions rose from 73 percent in wave 1 to 86 percent in wave 2. Similar to awareness of CER, however, the increase did not reach statistical significance.
Consumers reported an increase in awareness of AHRQ and the EHC Program from wave 1 to wave 2. Four percent of consumers indicated awareness of AHRQ in wave 1 and 11 percent reported awareness in wave 2; this change was statistically significant. Likewise, the percent of consumers reporting awareness of the EHC Program grew from four percent in wave 1 to seven percent in wave 2, but this increase did not reach statistical significance.
In addition to awareness, the team observed a statistically significant increase in consumers' interest in learning more about CER. Consumers indicating interest in learning more about evaluating treatment options for specific medical conditions grew from 37 percent in wave 1 to 51 percent in wave 2. Although the increase did not reach statistical significance, consumers' interest in evaluating treatment options to prepare for medical decisions increased from 69 percent in wave 1 to 74 percent in wave 2. Consumers also reported an increase in their intent to use CER to prepare for medical decisions, but the increase did not achieve statistical significance.
Interest in learning about the EHC Program increased over time from 44 percent in wave 1 to 58 percent in wave 2, and the increase was statistically significant. Consumers also reported an increase in intention to use AHRQ's products or other studies before a medical visit to inform decisionmaking from 39 percent in wave 1 to 45 percent in wave 2, although that increase was not statistically significant.
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7.2 Clinician Survey Findings
7.2.1 Wave 2 Clinician Survey Findings
Aided and unaided awareness among clinicians was relatively low. Clinicians were more familiar with the terms "evidence-based medicine" and "patient-centered outcomes research" than they were with the term "comparative effectiveness research." Almost half of the surveyed clinicians were aware of AHRQ; however, few respondents were aware of the EHC Program, its products, or the Eisenberg Center. Most who had heard of CER had learned about it through articles in medical journals, at a conference, or professional meeting. Though clinicians who were aware of the EHC Program were familiar with most of its products, use of these products was limited. Among all clinicians survey, about half of clinicians expressed interest in using EHC Program products in the next year.
While most respondents were not familiar with CER, knowledge and understanding was not high among those who were at least nominally aware of it. A large majority of clinicians correctly identified that CER compares effectiveness and risks of established and emerging treatments, is intended to support informed decisionmaking, addresses treatments for common chronic medical conditions, includes reviews of existing scientific literature, and is intended to assist in shared decisionmaking. However, a majority of clinicians incorrectly indicated that CER includes new scientific studies testing the efficacy of specific new medical treatments or technologies and many were unsure about who conducts CER studies.
Attitudes toward CER tended to be positive among respondents who had at least read or heard about it. A majority of respondents agreed that "CER provides findings that support informed decisionmaking" and "CER highlights current evidence about effectiveness, risks, and side effects." Slightly over half the respondents indicated that they were interested in learning more about CER; similarly, just over half indicated that they were interested in learning more about the EHC Program.
The majority of clinicians surveyed indicated that they share educational materials with their patients to help their patients make informed decisions about their treatment options. A large majority of clinicians indicated that they discuss treatment options with patients because patients ask them about their options. During these discussions, a majority of clinicians indicated that they describe the risks and benefits of each option, effectiveness of each option, and their experience with each option. Slightly less than half of clinicians reported that they discuss the potential costs of each option.
Common reasons for not discussing treatments options with patients included limited time, patients' existing awareness of treatment options, patients' expectations regarding the clinician's knowledge of the best treatment, concern about patients' difficulty in understanding treatment options; and patients being overwhelmed by the amount of information.
Those who were aware of the EHC Program (12 percent) most commonly mentioned knowledge of research reviews, original research reports, research summaries, clinician summaries, and continuing education activities. Though awareness of EHC Program products was generally high among clinicians who were aware of the EHC Program, few clinicians reported having ever read or used them. Among the respondents who had used any of the EHC Program products, slightly under half reported using the products in the last six months. Less than half of those surveyed indicated that they are likely to use the consumer and clinician summaries in the next year, while ten percent were unlikely to use either product. Approximately two-fifths of respondents were not sure if they would use either product.
The most common exposure to CER dissemination strategies was academic detailing. One-fifth of respondents reported that in the past 12 months they had taken an online CME/CE course that presented findings from a systematic evidence review that used CER to compare two or more treatment options. Slightly over half of the clinicians reported that they had seen, read, or heard messages that encourage patients to explore and compare their treatment options with their doctors. A majority of those exposed had been exposed to such messages within the last week or month.
7.2.2 Longitudinal Clinician Survey Findings
The longitudinal analysis comparing wave 1 to wave 2 suggests increases in awareness of and interest in CER, AHRQ, and the EHC Program among clinicians. Although changes in consumers' awareness of CER did not reach statistical significance, aided awareness increased from 18 percent in wave 1 to 20 percent in wave 2.
Clinicians reported statistically significant increases in both awareness of AHRQ and the EHC Program from wave 1 to wave 2. Thirty-three percent of clinicians indicated awareness of AHRQ in wave 1 and 38 percent reported awareness in wave 2. Likewise, the percent of clinicians reporting awareness of the EHC Program grew from eight percent in wave 1 to 12 percent in wave 2.
While awareness of CER, AHRQ, and the EHC Program increased, clinicians' knowledge and understanding decreased, although the changes were not statistically significant. Clinicians reported a slight decrease in the average CER Knowledge Score from 5.37 (out of 11) in wave 1 to 5.22 in wave 2. Clinicians' EHC Program Knowledge Score also declined from 6.39 (out of 11) in wave 2 to 6.32 in wave 2.
Like awareness, the team observed increases in clinicians' interest in learning more about CER and the EHC Program, although the changes were not statistically significant. Scores indicating clinicians' interest in learning more about CER increased slightly from 3.57 (out of 4) in wave 1 to 3.58 percent in wave 2. Clinicians also reported an increase in their interest in learning more about the EHC Program. In wave 1, clinicians reported a score of 3.61 (out of 4); in wave 2, the score grew slightly to 3.63.
Use of the EHC Program Web site among clinicians increased from wave 1 to wave 2 and the change was statistically significant. Twenty-eight percent of clinicians reported that they had previously visited the EHC Program Web site in wave 1; 41 percent reported visiting the Web site in wave 2. Clinicians also reported a slight increase in their intention to use EHC Program clinician products in the near future, although the change was not statistically significant. Fifty percent of clinicians reported intention to use EHC Program clinician products in wave 1; this figure increased by 0.1 percentage point in wave 2.
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7.3 Overall Findings
The longitudinal findings suggest that the investment in public education of consumers and clinicians is bearing fruit. Secular trends analyzed here indicate increased uptake in CER generally and, specifically, awareness of AHRQ and the EHC Program, as well as an interest in learning more about both CER and the EHC Program. The longitudinal findings also suggest that more clinicians are seeking out EHC Program resources, particularly its Web site.
Though the findings indicate a general increase in awareness and interest in CER, key findings from both the consumer and clinician surveys may help to guide and strengthen future public education and dissemination efforts. The findings from the consumer surveys suggest that consumers obtain information about CER from three primary sources: (1) print media, (2) Web sites, and (3) health care providers. The findings also show that consumers have a growing interest in learning more about evaluating treatment options for specific medical conditions, as well as an increasing interest in learning more about the EHC Program. Future public education and dissemination efforts may want to consider reaching consumers at the locations in which they currently receive information, (such as newspapers, magazines, and the Internet) and focus research dissemination on specific conditions in which patients and their families often seek medical advice.
Furthermore, the findings from the clinician surveys suggest that a majority of clinicians share education materials with their patients, and most do so because their patients ask them for treatment options in general or because their patients ask about specific options. Continuing education to health care providers on CER, particularly on the benefits and usefulness of this type of research, may increase awareness and use of CER among both clinicians and consumers. Findings from the clinician surveys suggest that the most common sources of exposure to CER among clinicians are academic articles, conference or professional meetings, and continuing education courses. Future public education and dissemination efforts may want to consider continuing to target these points of exposure, as well as expanding these efforts to integrate information on how to use CER in the practice setting with patients. Additionally, given the higher levels of awareness of evidence based medicine compared to CER, AHRQ may want to consider targeting EHC Program products to clinicians that assist them in practicing evidence based medicine.
As consumers and clinicians gain more access to information about CER and the EHC Program, a third survey could further compare trends in awareness, knowledge, attitudes, and use of CER. Such data may help to strengthen dissemination efforts and increase consumer and clinician's access to and use of CER and the EHC Program to inform health care decisionmaking.
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