I’ve been involved in clinical uncertainties for many years. I had the pleasure of helping create the DUETs database (UK Database of Uncertainties about the Effects of Treatments). Around the same time Trip released the Tag Cloud of Clinical Uncertainty which was a great experiment. In all aspects of my professional life I like to highlight the importance of clinical uncertainty. Although the term often unnerves people, I think they feel threatened by the notion. But, it could be worse, the likes of Iain Chalmers and Muir Gray have often used the phrase clinical ignorance – which is far harsher.
My interest in uncertainties stems from my desire to improve the research procurement process. The main drive with Trip is to help clinicians answer their clinical questions. Without knowing the gaps in their knowledge and the evidence base how can you procure suitable primary research or even secondary, evidence synthesis? Myself and my teams have answered over 10,000 clinical questions so we know how frequently the research base is lacking or not focused on clinical care. So things need to improve and I think recording uncertainties is a great way to help.
I raise all this as, in my business planning, I’ve spoken to one of the UK’s largest research ‘agency’ and they are keen to work with Trip to better understand users questions and gaps in the evidence base. So, for me, the answer is to try and capture the clinical questions our users have and when Trip has let them down. I have a few ideas around this, including creating a PICO+ tool; a step-by-step tool to allow users to easily answer their clinical questions. The user would start by adding the full question and then we would guide them through the PICO steps (e.g. what is the population, what is the intervention). At the end they can tell us if their question has been answered. If not, it’s got a good chance of being a clinical uncertainty.
Seems like a plan!