In healthcare, there are gaps and conflicting ideas everywhere. Will aspirin protect against future heart attacks? Will melatonin help manage jet lag? What about antibiotics for a sore throat? In some areas there is certainty within the scientific evidence and agreement on best practice. But sadly, this is not as common as people think. There is a lot of research evidence for using aspirin and it is clear (and mostly common practice) that it is useful for those people who have had a heart attack or a stroke. On the other hand, the research evidence suggest that melatonin is effective in preventing and reducing jet lag, yet it is not widely available or recommended! And now for antibiotics – the wonder drug that transformed health care infections in the 1950’s and 1960’s. We know from experience and research evidence that most sore throats will get better on their own in 3-4 days; the research evidence tells us that antibiotics can protect from rare complications and may reduce the time people feel ill by 16 hours. They also have negative effects of causing rashes, diarrhoea and building resistance in communities. So what should you do next time you have a sore throat?
Knowledge is the basis for decision-making and it is people who make the decisions. People can be rational, but the process of making decisions is not always clear and logical in a linear step-by step fashion. There is often tension between whether knowledge is easily available, and therefore whether it is important to look for, organise and use it. Table 1 in the K*concept paper describes 4 different scenarios in the tension between demand and supply of knowledge that is either focused or fragmented. There is an interesting discussion about needing to understand complexity to make better decisions. There is ongoing significant research around this area of making decisions along the same continuum from being focused to fragmented. The challenge is to share and use research across different domains of practice. Maybe it is easier to understand and change behaviour – that will be another post!