Wilkes University

Evidence-Based Practice and Information Mastery: POEMs and DOEs

A guide on the method of applying evidence-based practice to combat information overload and help the practitioner locate, evaluate and integrate the best information to improve the quality of care for the patient.

POE(M)s and DOEs

In information mastery as well as in evidence-based practice from which it grew, the patient is at the center of the decision making process, including the selection of the treatment (intervention) and whether the treatment is a success (outcome). So 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 refers to outcomes of studies that measure things a patient would care about, such as improvement of symptoms, quality of life, cost of the intervention, morbidity or mortality, length of stay, etc.—essentially whether the intervention helps patients live longer or better lives. If a POE would change practice, it becomes a POEM (Patient-Oriented Evidence that Matters).

While patient-oriented evidence is becoming more common, 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.

For example, a study might look at the use of B vitamins and folic acid supplements to lower homocysteine levels. Since homocysteine is an independent predictor of the risk of developing cardiovascular disease, practitioners could logically come to the conclusion that using these supplements will prevent or treat CVD. However the HOPE trial (N Engl J Med 2006;354:1567-1577) showed that there was no difference in the combined risk of cardiovascular death, myocardial infarction, or stroke between groups who used vitamin B and folic acid and those who did not. So patients may spend money for preparations that do lower a number on a lab test but ultimately make no difference in their risk of heart disease and death.

Another example of a DOE would be a study that looked at the sensitivity and specificity of PSA testing in diagnosing prostate cancer. But does diagnosing prostate cancer via this test improve the outcome for the patient?  The diagnosis may lead to radical surgery that leads to impotence or incontinence when, in fact, a patient may live many years with the disease and eventually die of another cause.

These differences between DOEs and POE(M)s are important to the concept of 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.