General Practitioners' use and understanding of the quantitative benefits and harms of treatments for common long-term conditions: a qualitative interview study.
Treadwell JS., Crocker J., Rushforth A., Mahtani KR., Greenhalgh T.
BACKGROUND: To support shared decision making and improve the management of polypharmacy, it is recommended that GPs take into account quantitative information on the benefits and harms of treatments. Quantitative evidence shows GPs' knowledge of this is low. AIM: To explore GPs' attitudes to and understanding of the quantitative benefits and harms of treatments for long term conditions. DESIGN AND SETTING: Qualitative interview study in UK General Practice. METHOD: Semi-structured interviews with 15 GPs. Audio-recordings were transcribed verbatim and a framework approach used for analysis. RESULTS: Participants described knowing or using quantitative information on benefits and harms for only a few treatments. There was awareness of this knowledge deficit coupled with low confidence in statistical terminology. Some perceived an absence of this information as an important barrier to optimal care, others were content to follow guidelines. In the absence of this knowledge, other strategies were described to individualise treatment decisions. The idea of increasing the use of quantitative information on the benefits and harms of treatment appealed to most, with imagined benefits for patients and themselves. However, potential barriers were described: a need for accessible information that can be understood and integrated into real-world practice, system factors and communication challenges. CONCLUSION: GPs are aware of their knowledge deficit with regard to an understanding of quantitative benefits and harms of treatments. Most were positive about the idea of increasing their use of this in practice but described important challenges which need to be considered when designing solutions.