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Evidence-Based Patient Choice

One of the objectives of Bandolier is to promote evidence-based health care, and the components of evidence-based health care are summarised in the diagram.

There are, of course, many other topics not specifically mentioned in the diagram which are components of evidence-based health care - for example evidence-based audit and screening.

Evidence-based patient choice

One of the key components in the development of evidence-based health care is evidence-based patient choice, namely helping patients not only increase their knowledge about options but also helping them understand what is meant by the strength of evidence available to them. In the Northamptonshire GRiP project, for example, a simple approach is used to indicate to patients and their carers the strength of evidence about different aspects of stroke management.

Evidence-based consumer choice

In evidence-based "patient choice", women who are pregnant are not patients and information for them should probably be called "evidence-based consumer choice". There are other examples, for instance about evidence-based eating for health, where the target is not a patient, but a member of the public.

A landmark in consumer choice was reached with the publication of the first edition of "Effective Care in Pregnancy and Childbirth" in 1989. This was a book for consumers based on "a systematic hand search of over 63 journals from the 1950s onwards" and a survey of "over 40,000 obstetricians and paediatricians in 18 countries in an attempt to identify unpublished studies".

The result of this major effort was a 15,000 page book in two large volumes - "Effective Care in Pregnancy and Childbirth", and the regularly updated electronic database of systematic reviews - the Cochrane Pregnancy and Childbirth Database [1].

The second edition of this book has now been published [2] and is excellent not only for women who are pregnant but also for anyone interested in evidence-based health care. This is in part because of its approach, in part because of the appendix which gives a very clear classification of different forms of care. It groups different forms of care into six different forms, those which are :-
  • beneficial
  • likely to be beneficial
  • with a known trade-off between beneficial and adverse effects
  • of unknown effectiveness
  • unlikely to be beneficial
  • likely to be ineffective or harmful
The review of the first edition said that "there are few books that should be considered as essential reading in obstetrics, but this is certainly one of them". It could well be said that there are few books that can be considered as essential reading in evidence-based health care, and this is certainly one of them.


  1. M Enkin, MJ Keirse, M Renfrew, J Neilson. Effective care in pregnancy and childbirth. Oxford University Press, 1989.
  2. M Enkin, MJ Keirse, M Renfrew, J Neilson. A guide of effective care in pregnancy and childbirth. Oxford University Press, 1995.

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