What are treatment uncertainties?
People have suffered and died unnecessarily because uncertainties about the effects of treatments have not been addressed in research (Confronting Therapeutic Ignorance
; Well informed uncertainties about the effects of treatments
; Testing Treatments
). Patients and the public have a right to expect that research funders, researchers and health professionals will identify uncertainties about whether treatments are doing more harm than good or whether one treatment is better than another, and should expect them to organise the research needed to reduce the most important of these uncertainties. Indeed, the General Medical Councilís advice to doctors is that they "must work with colleagues and patients...to help resolve uncertainties about the effects of treatments" (Good Medical Practice, para 14f, page 13
The JLA definition of a treatment uncertainty is that:
- no up-to-date, reliable systematic reviews of research evidence addressing the uncertainty about the effects of treatment exists
- up-to-date systematic reviews of research evidence show that uncertainty exists
It can include other health care interventions, including prevention, testing and rehabilitation. Systematic
reviews are based on worldwide searches for reliable, relevant evidence.
are comprehensive summaries and analyses of comparable published and
unpublished studies of effectiveness, prepared by a team of authors. Systematic
reviews are used to inform health and social care service development, policy
development, and research.
To help ensure that treatments do more good than harm, gaps in knowledge about their effects - uncertainties - must be identified, and those deemed sufficiently important must be addressed in research.
Research on the effects of treatments is usually led by researchers or funders. This can mean that it can fail to address questions that matter to patients and to the clinicians to whom patients look for help. This is why the JLA process focuses on patients and clinicians.