知證衛生政策工具之十七——研究證據不足時的知證決策*_《中國循證醫學雜志》

作者：

Andrew D Oxman ¹ , John N Lavis ² , Atle Fretheim ³ , Simon Lewin ⁴

關鍵詞：

DOI：

10.7507/1672-2531.20100442

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本文擬解決證據不足情況下的決策問題。決策者通常沒有充足的證據來確定某衛生政策或項目方案會帶來哪些影響，但他們仍必須做出決策。當沒有充分證據確定實施方案效果時，我們建議考慮以下4 個問題：①是否有該方案效果的系統評價？② 是否將不確定性證據誤解為該方案無效的證據？③ 盡管缺乏證據，是否能對該項決策充滿信心？④ 所選方案是否會產生潛在危害或無效或價無所值？

引用本文： Andrew D Oxman,John N Lavis,Atle Fretheim,Simon Lewin. 知證衛生政策工具之十七——研究證據不足時的知證決策*. 中國循證醫學雜志, 2010, 10(5): 534-538. doi: 10.7507/1672-2531.20100442 復制

1.	Lavis JN, Oxman AD, Lewin S, et al. SUPPORT Tools for evidenceinformed health Policymaking (STP). Introduction. Health Res Policy Syst, 2009, 7(Suppl 1): I1.
2.	Grobler LA, Marais BJ, Mabunda S, et al. Interventions for increasing the proportion of health professionals practising in underserved communities. Cochrane Database Syst Rev, 2009, 1:CD005314.
3.	Lavis JN, Oxman AD, Grimshaw J, et al. SUPPORT Tools for evidence- informed health Policymaking (STP). 7. Finding systematic reviews. Health Res Policy, 2009, 7(Suppl 1): S7.
4.	Lewin S, Oxman AD, Lavis JN, et al. SUPPORT Tools for evidenceinformed health Policymaking (STP). 8. Deciding how much confidence to place in a systematic review. Health Res Policy Syst, 2009, 7(Suppl 1):S8.
5.	Chopra M, Munro S, Lavis JN, et al. Effects of policy options for human resources for health: an analysis of systematic reviews. Lancet, 2008, 371: 668-674.
6.	Lewin S, Lavis JN, Oxman AD, et al. Supporting the delivery of costeffective interventions in primary health-care systems in low-income and middle-income countries: an overview of systematic reviews. Lancet, 2008, 372: 928-939.
7.	Oxman AD, Schunemann HJ, Fretheim A. Improving the use of research evidence in guideline development: 8. Synthesis and presentation of evidence. Health Res Policy Syst, 2006, 4: 20.
8.	Lavis JN, Oxman AD, Lewin S, et al. SUPPORT Tools for evidenceinformed health Policymaking (STP). 3. Setting priorities for supporting evidence-informed policymaking. Health Res Policy Syst, 2009, 7(Suppl 1): S3.
9.	Alderson P, Chalmers I. Survey of claims of no effect in abstracts of Cochrane reviews. BMJ, 2003, 326: 475.
10.	Centers for Disease Control (CDC). Surgeon General’s advisory on the use of salicylates and Reye syndrome. MMWR Morb Mortal Wkly Rep, 1982, 31: 289-290.
11.	Chalmers I. If evidence-informed policy works in practice, does it matter if it doesn’t work in theory? Evidence & Policy, 2005, 1(2): 227-242.
12.	Oxman AD, Lavis JN, Lewin S, et al. SUPPORT Tools for evidenceinformed health Policymaking (STP). 1. What is evidence-informed policymaking. Health Res Policy Syst, 2009, 7(Suppl 1): S1.
13.	Hahn S, Kim S, Garner P. Reduced osmolarity oral rehydration solution for treating dehydration caused by acute diarrhea in children. Cochrane Database Syst Rev, 2002, 1: CD002847.
14.	Duley L, Henderson-Smart D. Magnesium sulphate versus diazepam for eclampsia. Cochrane Database Syst Rev, 2003, 4: CD000127.
15.	Duley L, Henderson-Smart D. Magnesium sulphate versus phenytoin for eclampsia. Cochrane Database Syst Rev, 2003, 4: CD000128.
16.	Villar J, Carroli G, Khan-Neelofur D, et al. Patterns of routine antenatal care for low-risk pregnancy. Cochrane Database Syst Rev, 2001, 4: CD000934.
17.	Alderson P, Roberts I. Corticosteroids for acute traumatic brain injury. Cochrane Database Syst Rev, 2005, 1: CD000196.
18.	Liberati A, Moja L, Moschetti I, et al. Human albumin solution for resuscitation and volume expansion in critically ill patients. Intern Emerg Med, 2006, 1: 243-245.
19.	Farquhar C, Marjoribanks J, Lethaby A, et al. Long term hormone therapy for perimenopausal and postmenopausal women. Cochrane Database Syst Rev, 2009, 2:CD004143.
20.	Enayati AA, Hemingway J, Garner P. Electronic mosquito repellents for preventing mosquito bites and malaria infection. Cochrane Database Syst Rev, 2007, 2: CD005434.
21.	Guyatt GH, DiCenso A, Farewell V, et al. Randomized trials versus observational studies in adolescent pregnancy prevention. J Clin Epidemiol, 2000, 53:167-74.
22.	Volmink J, Garner P. Directly observed therapy for treating tuberculosis. Cochrane Database Syst Rev, 2007, 4: CD003343.
23.	Austvoll-Dahlgren A, Aaserud M, Vist G, et al. Pharmaceutical policies: effects of cap and co-payment on rational drug use. Cochrane Database Syst Rev, 2008, 1: CD007017.
24.	Devereaux PJ, Choi PT, Lacchetti C, et al. A systematic review and meta-analysis of studies comparing mortality rates of private for-profit and private not-for-profit hospitals. CMAJ, 2002, 166: 1399-1406.
25.	Oxman AD, Fretheim A. An overview of research on the effects of resultsbased financing. Report Nr 16-2008 2008 [http://www. kunnskapssen teret.no/Publikasjoner/3219.cms]. Oslo: Nasjonalt kunnskapssenter for helsetjenesten.
26.	Lagarde M, Palmer N. The impact of contracting out on health outcomes and use of health services in low and middleincome countries. Cochrane Database Syst Rev, 2009, 4: CD008133.
27.	Chalkidou K, Hoy A, Littlejohns P. Making a decision to wait for more evidence: when the National Institute for Health and Clinical Excellence recommends a technology only in the context of research. J R Soc Med, 2007, 100:453-60.
28.	Moynihan R, Oxman A, Lavis JN, et al. Evidence-Informed Health Policy: Using Research to Make Health Systems Healthier. Rapport nr. 1- 2008 2008 [http://www.kunnskapssenteret.no/Publikasjoner/ 469.cms]. Oslo: Nasjonalt kunnskapssenter for helsetjenesten.
29.	Fretheim A, Oxman AD, Lavis JN, et al. SUPPORT Tools for evidenceinformed health Policymaking (STP). 18. Planning monitoring and evaluation of policies. Health Res Policy Syst, 2009, 7(Suppl 1): S18.
30.	Lavis JN, Oxman AD, Souza NM, et al. SUPPORT Tools for evidence- informed health Policymaking (STP). 9. Assessing the applicability of the findings of a systematic review. Health Res Policy Syst, 2009, 7(Suppl 1): S9.
31.	UK Cabinet Office. Modernising government: presented to parliament by the prime minister and the minister for the Cabinet Office by command of Her Majesty. Cm 4310 1999 [http://www.archive. official-docu ments.co.uk/document/cm43/4310/4310-00.htm]. London: Stationary Office.
32.	Macintyre S, Chalmers I, Horton R, et al. Using evidence to inform health policy: case study. BMJ, 2001, 322: 222-225.

1. Lavis JN, Oxman AD, Lewin S, et al. SUPPORT Tools for evidenceinformed health Policymaking (STP). Introduction. Health Res Policy Syst, 2009, 7(Suppl 1): I1.
2. Grobler LA, Marais BJ, Mabunda S, et al. Interventions for increasing the proportion of health professionals practising in underserved communities. Cochrane Database Syst Rev, 2009, 1:CD005314.
3. Lavis JN, Oxman AD, Grimshaw J, et al. SUPPORT Tools for evidence- informed health Policymaking (STP). 7. Finding systematic reviews. Health Res Policy, 2009, 7(Suppl 1): S7.
4. Lewin S, Oxman AD, Lavis JN, et al. SUPPORT Tools for evidenceinformed health Policymaking (STP). 8. Deciding how much confidence to place in a systematic review. Health Res Policy Syst, 2009, 7(Suppl 1):S8.
5. Chopra M, Munro S, Lavis JN, et al. Effects of policy options for human resources for health: an analysis of systematic reviews. Lancet, 2008, 371: 668-674.
6. Lewin S, Lavis JN, Oxman AD, et al. Supporting the delivery of costeffective interventions in primary health-care systems in low-income and middle-income countries: an overview of systematic reviews. Lancet, 2008, 372: 928-939.
7. Oxman AD, Schunemann HJ, Fretheim A. Improving the use of research evidence in guideline development: 8. Synthesis and presentation of evidence. Health Res Policy Syst, 2006, 4: 20.
8. Lavis JN, Oxman AD, Lewin S, et al. SUPPORT Tools for evidenceinformed health Policymaking (STP). 3. Setting priorities for supporting evidence-informed policymaking. Health Res Policy Syst, 2009, 7(Suppl 1): S3.
9. Alderson P, Chalmers I. Survey of claims of no effect in abstracts of Cochrane reviews. BMJ, 2003, 326: 475.
10. Centers for Disease Control (CDC). Surgeon General’s advisory on the use of salicylates and Reye syndrome. MMWR Morb Mortal Wkly Rep, 1982, 31: 289-290.
11. Chalmers I. If evidence-informed policy works in practice, does it matter if it doesn’t work in theory? Evidence & Policy, 2005, 1(2): 227-242.
12. Oxman AD, Lavis JN, Lewin S, et al. SUPPORT Tools for evidenceinformed health Policymaking (STP). 1. What is evidence-informed policymaking. Health Res Policy Syst, 2009, 7(Suppl 1): S1.
13. Hahn S, Kim S, Garner P. Reduced osmolarity oral rehydration solution for treating dehydration caused by acute diarrhea in children. Cochrane Database Syst Rev, 2002, 1: CD002847.
14. Duley L, Henderson-Smart D. Magnesium sulphate versus diazepam for eclampsia. Cochrane Database Syst Rev, 2003, 4: CD000127.
15. Duley L, Henderson-Smart D. Magnesium sulphate versus phenytoin for eclampsia. Cochrane Database Syst Rev, 2003, 4: CD000128.
16. Villar J, Carroli G, Khan-Neelofur D, et al. Patterns of routine antenatal care for low-risk pregnancy. Cochrane Database Syst Rev, 2001, 4: CD000934.
17. Alderson P, Roberts I. Corticosteroids for acute traumatic brain injury. Cochrane Database Syst Rev, 2005, 1: CD000196.
18. Liberati A, Moja L, Moschetti I, et al. Human albumin solution for resuscitation and volume expansion in critically ill patients. Intern Emerg Med, 2006, 1: 243-245.
19. Farquhar C, Marjoribanks J, Lethaby A, et al. Long term hormone therapy for perimenopausal and postmenopausal women. Cochrane Database Syst Rev, 2009, 2:CD004143.
20. Enayati AA, Hemingway J, Garner P. Electronic mosquito repellents for preventing mosquito bites and malaria infection. Cochrane Database Syst Rev, 2007, 2: CD005434.
21. Guyatt GH, DiCenso A, Farewell V, et al. Randomized trials versus observational studies in adolescent pregnancy prevention. J Clin Epidemiol, 2000, 53:167-74.
22. Volmink J, Garner P. Directly observed therapy for treating tuberculosis. Cochrane Database Syst Rev, 2007, 4: CD003343.
23. Austvoll-Dahlgren A, Aaserud M, Vist G, et al. Pharmaceutical policies: effects of cap and co-payment on rational drug use. Cochrane Database Syst Rev, 2008, 1: CD007017.
24. Devereaux PJ, Choi PT, Lacchetti C, et al. A systematic review and meta-analysis of studies comparing mortality rates of private for-profit and private not-for-profit hospitals. CMAJ, 2002, 166: 1399-1406.
25. Oxman AD, Fretheim A. An overview of research on the effects of resultsbased financing. Report Nr 16-2008 2008 [http://www. kunnskapssen teret.no/Publikasjoner/3219.cms]. Oslo: Nasjonalt kunnskapssenter for helsetjenesten.
26. Lagarde M, Palmer N. The impact of contracting out on health outcomes and use of health services in low and middleincome countries. Cochrane Database Syst Rev, 2009, 4: CD008133.
27. Chalkidou K, Hoy A, Littlejohns P. Making a decision to wait for more evidence: when the National Institute for Health and Clinical Excellence recommends a technology only in the context of research. J R Soc Med, 2007, 100:453-60.
28. Moynihan R, Oxman A, Lavis JN, et al. Evidence-Informed Health Policy: Using Research to Make Health Systems Healthier. Rapport nr. 1- 2008 2008 [http://www.kunnskapssenteret.no/Publikasjoner/ 469.cms]. Oslo: Nasjonalt kunnskapssenter for helsetjenesten.
29. Fretheim A, Oxman AD, Lavis JN, et al. SUPPORT Tools for evidenceinformed health Policymaking (STP). 18. Planning monitoring and evaluation of policies. Health Res Policy Syst, 2009, 7(Suppl 1): S18.
30. Lavis JN, Oxman AD, Souza NM, et al. SUPPORT Tools for evidence- informed health Policymaking (STP). 9. Assessing the applicability of the findings of a systematic review. Health Res Policy Syst, 2009, 7(Suppl 1): S9.
31. UK Cabinet Office. Modernising government: presented to parliament by the prime minister and the minister for the Cabinet Office by command of Her Majesty. Cm 4310 1999 [http://www.archive. official-docu ments.co.uk/document/cm43/4310/4310-00.htm]. London: Stationary Office.
32. Macintyre S, Chalmers I, Horton R, et al. Using evidence to inform health policy: case study. BMJ, 2001, 322: 222-225.

《中國循證醫學雜志》

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《中國循證醫學雜志》

知證衛生政策工具之十七——研究證據不足時的知證決策*

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