The art of using research to help clinical decision making

How can you find and interpret research papers that can genuinely help your clinical practice?
 
That is the question that Professor Paul Glasziou, the Director of Bond University’s Institute for Evidence-Based Healthcare, addresses in a new webinar How to read a paper: Navigating the maze.

One of the world’s most highly cited researchers, and a previous director of the Centre for Evidence-Based Medicine at Oxford University, Professor Glasziou also worked for many years as a GP – and said he would often consider how best to use studies to inform his work.
 
‘I was a … part-time general practitioner for over 20 years, and in that time I really spent a lot of time grappling with how I could better use research evidence to assist with patient decision-making, sometimes with individual patients or sometimes with category problems that our practice had,’ he said.
 
‘In that time I have learned a lot of little tips and tricks … about just how to make it easier and quicker to read a paper.’
 
With the amount of research papers available increasing exponentially, the question on how to find and interpret research and decide whether it is useful or not remains more pertinent than ever.
 
The webinar is designed to help clinicians pinpoint good evidence more confidently, parse research critically and to identify ways to improve clinicians’ skills in choosing and reading papers.
 
Professor Glasziou set out a series of tools, including mnemonics, that can help busy GPs work out whether research is likely to help them.
 
As well as setting out the anatomy of a typical research paper, he describes key features to look for in published research, including the attrition rate, and whether it is randomised or representative, blinded or objective.
 
He also addresses questions about identifying bias in a study, the relevance of hazards and odds ratios, and the importance of recognising what types of study are most appropriate for the outcome being considered.
 
‘Even if they have got the right study design they may have not necessarily conducted the study well enough to avoid major bias, so we also need to do a rapid critical appraisal,’ he said.
 
‘You might think that just because it has been peer-reviewed that it must be okay. That is not true.’
 
Professor Glasziou references the occasional fallibility of even the most highly regarded journals, citing as an example the now retracted study on hydroxychloroquine that was published in The Lancet towards the beginning of the pandemic.
 
‘The good journals can make mistakes, but the lower tier journals often have very poor-quality studies in them, so you do need to look at what the quality of the study is,’ he said.
 
Professor Glasziou also advises on ways of being analytical to hone practice, from keeping a logbook of questions to having regular discussions about clinical issues and papers.
 
In particular he references a regular ‘Journal club’ that he used to participate in.
 
‘It doesn’t have to be a research paper, it can also be going through a guideline and checking the evidence and information that is in a guideline as well,’ he said. 
 
‘It is a great place to bring up the things that you are worried about in practice.
 
‘People used to come along on their day off because they enjoyed it so much, I highly recommend trying to do it yourself.’
 
The ‘How to read a paper’ webinar is described as suitable ‘for anyone interested in research, including students, early career researchers, curious GPs, and other curious primary care clinicians and service providers’.
 
A recording of the webinar is now available on demand for members on the RACGP website and attracts two CPD points.
 
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