Health Science

Cochrane Consumers and Communication Review Group

Potential review topics

We invite proposals for Cochrane reviews based on the topics below.

For further information please contact Megan Prictor in the first instance.

Librarians / information specialists providing targeted health information to consumers... Patient information prescriptions...

Libraries and information services have a valuable role in disseminating health information to consumers. Some researchers are examining the effectiveness of interventions such as patient information prescriptions, which are ‘filled’ by a librarian trained in the provision of tailored health information. Contact Megan Prictor for more details and references relating to this proposed topic.

Submitted by: anonymous, November 2007

Enabling patients and their advocates to call ‘rapid response teams’ in hospitals

Hospital quality and safety initiatives targeting patient and carer involvement are the focus of increasing interest. A review might examine the effects of enabling patients and their advocates to call 'rapid response teams' (also known as ‘Medical Emergency Teams’). These interventions are sometimes described as 'patient-activated' or 'patient-initiated' response teams. See, for instance:

• Shirley S. Wang “Teaming up to prevent ‘crashes’: some hospitals give patients the power to get extra help, stat,” The Washington Post, September 4, 2007; Page HE01.
• Patrice L. Spath, "Empowering families in emergencies," Hospitals and Health Networks.

Submitted by: Megan Prictor, October 2007

Interventions to improve informed decision making during and shortly after childbirth

Labor is too late to begin informed consent processes about intrapartum care and involves suboptimal conditions for learning about options and making informed choices. If a woman learns about her options at that point, she may find that the care that she prefers is not even be available in the setting where she is laboring. Existing evidence suggests that in many instances very inadequate processes for informed consent are carried out with laboring women. Prenatal visits are often brief and focused on pregnancy issues. Yet it is difficult to predict ahead of time how labor will go. Recent associations of oxytocin with trust suggest that laboring women with surging endogenous oxytocin may find it difficult to avoid intrapartum care that is offered and is not in their self-interest.

In recent surveys of postpartum women in Australia, UK, and USA, mothers expressed a high degree of interest in knowing all or most downsides of epidural analgesia before consenting to this procedure. The national US survey (Childbirth Connection’s Listening to Mothers survey) also asked about interest in knowledge of adverse effects of labor induction and cesarean section, with similar results. By contrast, the overall knowledge of Listening to Mothers participants about adverse effects of these three consequential and increasingly common labor interventions was poor. (UK and Australia data were reported in Bethune et al. Int J Obstet Anesth 2004;13(1):30-4).

This is priority topic due to the extent of childbearing (about 125 million babies are born every year globally), and because much maternity care practice is not evidence-based. Troubling rates of interventions developed for women in special circumstances or shown to be ineffective overall have come to be used in healthy mothers and babies, offering risk without benefit and draining health resources. A major strategy for improving the field is to engage women themselves in obtaining more appropriate care.

Submitted by: Carol Sakala, 14 April 2006

Complementary and alternative medicines - communication between people with cancer and their oncologists

People with cancer who are interested in complementary, and in particular alternative approaches (CAM) to their disease often have difficulties in discussing them with oncologists. There are many studies of vitamins and nutrition, for example - patients see the ones with good outcomes, oncologists notice the ones with negatives. The conversation between them is fraught with tension. Has this been studied/reviewed with an eye toward easing this communication?

We know surveys of CAM use have been done. And they often show patients withholding information. Yet people with cancer persist in using, exploring and thinking about CAM - to offset the unwanted effects of treatment, after treatment, when treatment has failed, etc.

Submitted by: Ann Fonfa, USA; 29 March 2006.