Comparative Effectiveness Research in Practice and Policy for Radiation Oncology

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Interest in comparative effectiveness research (CER) has increased dramatically over the past decade, yet perceptions about what comprises CER varies. CER has several attributes relevant to practice and policy: (1) The goal of CER is to inform decisions about health care. (2) Literature synthesis is used in addition to primary research. (3) CER evaluates not only overall outcomes for the population but also evaluates subgroups that may have heterogeneous outcomes. (4) Research places an emphasis on outcomes in the “real-world” settings. (5) Outcomes studied should be relevant to patients. In radiation oncology, where many of the traditional clinical trials are comparative in nature, the line between CER and “traditional” research may be blurred, but an increased emphasis on CER can help to bridge the research enterprise and clinical practice, helping to inform decision making at the patient, clinician, and policy levels.

Section snippets

What We Know

A major role of CER is to inform clinicians in their practice, both for the purposes of their decision making and for informing their patients so that they are better able to participate in shared decision making regarding their health care options. One of the primary ways that CER can inform physicians is to help understand what is currently known through systematic reviews that provide thorough syntheses on available research literature on health care interventions. In our rapidly evolving

Informing Patients

Information from CER is aimed at informing patient decision making, as well as clinician decision making. Shared decision making involves at least the clinician and the patient,24, 25 and it may include others such as family members. A critical part of this process involves informing patients about the potential benefits and harms of their health care options. CER has helped support patient decision making by providing outcomes data to inform patients about relevant outcomes. If the benefits of

Informing Policy

Although CER has the potential to be applicable to a wide range of policy applications—for example, pharmacy formulary decision making, acquiring a facility to add PBT to current institutional capacity, insurance coverage, and reimbursement—finding clear evidence of use of research to inform these decision-making processes is not always available in the published literature. The conceptual approach is similar; however, the goal of CER for policy applications would be to help inform decision

Conclusions

As the explicit goal of CER is to inform decisions about health care, this research helps to bridge the traditional research enterprise to clinical practice and to health care policy. Inclusion of literature syntheses in CER helps to provide a comprehensive view of what we know from existing research, and provides a clear understanding of research gaps. Focusing new research on these gaps will address important areas of uncertainty that may hinder optimal decision making about health care

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    Disclaimer: The opinions expressed here are those of the author and do not represent official policy of the Agency for Healthcare Research and Quality or the Department of Health and Human Services.

    The author declares no conflict of interest.

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