POE(M)s and DOEs
Seeking outcomes that matter to the patient (and, therefore, to the practitioner) is an important consideration when developing a PICO question and using it to search the literature for research studies.
This kind of evidence is called Patient-Oriented Evidence (POE) and describes outcomes of importance to the patient:
Improvement of symptoms
Reduction in pain
Quality of life
Cost of the intervention
Length of stay
POEs are essentially interventions that help patients live longer or better lives. If a POE would change practice, it becomes a POEM (Patient-Oriented Evidence that Matters).
Patient-oriented evidence is becoming more common, but the medical literature is full of examples of studies that relate Disease-Oriented Evidence (DOE). These studies illuminate the etiology, prevalence and pathophysiology of diseases. They give us insight into the disease process but are less helpful in the clinical management of patients. In fact, in many studies preliminary data were promising or intermediate results looked good, but when real patients and outcomes were measured, results were disappointing or even showed the intervention to be unsafe.
Examples of Disease vs. Patient Oriented Evidence
DOE: Beta-carotene and vitamin E are good antioxidants
POE: Neither vitamin prevents cancer or cardiovascular disease
DOE: Antiarrythmic drug X is decreases the incidence of premature ventricular contractions on ECGs
POE: Antiarrythmic drug X is associated with an increase in mortality
The differences between DOEs and POE(M)s are important to the concept of EBM and Information Mastery. With today’s rapid increase in the amount of published information, the health care professional’s obligation to stay up to date, and the limits of time, your efforts should focus on identifying, validating and applying POEMs in your practice.