The expectations that clinicians have are not necessarily those of patients
Conducted on 17 March 2019 by Dr Rachel Giles
Prof. Chris Chapple is Urologist in Sheffield, UK, and Secretary-General of the EAU
As a professional society, the EAU is characteristically strong in promoting evidence-based medicine. Is the vision equally strong in promoting innovative/hypothesis-driven urological research?
Thank you, you really raise the important issue of evidence-based medicine. And clearly in our Association, the mission statement we have is to raise the standard of urological care across Europe and beyond to provide the best service to patients. In order to do that, we need to obviously know what the level of knowledge is and how robust the evidence is regarding that.
So clearly an evidence-based approach is the essential way of moving forward, so we’ve devoted a lot time and energy and cost into our Guidelines, which are updated on a yearly basis. So you have the most up-to-date information available. This, of course, then leads on to the fact that -clearly- there are lots of areas where we do not really have an answer. But the whole point of modern guidelines is to use an approach where you formulate a research question, you then look at the population that you are considering, and based on that, you look at the evidence that exists and thereby you have a lot of research questions where you can see that there is a need for future evaluation.
This then of course allows us to look into these areas where the knowledge is not robust and therefore to set up clinical research in those areas. Another question of course relates to exploratory research. And we are committed to that in the Association -with our Scholarship Programme, with our EAU Research Foundation- where we are aiming to support and develop research in all the areas of urology, whether in functional urology or in particular in oncology, where there is a great deal of need for further developments in knowledge.
The EAU has recently begun to partner with patient organisation to improve implementation of best practices?
Thank you. You raise an important question of how we work with patient organisations to provide the best quality of care. I think it is absolutely vital that we work with patient organisations. Well, you may say that I would say that, as somebody who is helping run the European Association of Urology. But I think that actions speak more than words. And I was involved in -in fact I led the process- the European Reference Network in urology, where we worked very closely with patient organisations in developing a network where we can provide unbiased, expert advice on cases across Europe. Using a secure platform, where clinicians can submit cases where they need advice and support where we actually can share x-rays and the clinical information which clearly needs to be kept confidential, because it’s a confidential network which is run by the European Commission, and this deals with the areas of uncommon congenital problems, uncommon oncological problems, and uncommon functional urological problems. This obviously provides support to clinicians. And in doing this we work very closely with patient organisations because – of course- they define the unmet needs, and -of course- the expectations that clinicians have are not necessarily those of consumers, in other words, patients. So it’s a quid pro quo. In my career in my own country, I have chaired a NICE committee (editor: NICE is the agency for post-marketing health technology appraisal to fund and market medicines in the UK), and have been involved in other committees, and the most invaluable contribution –I found- has been from the patients who are involved on those committees that has brought us down to Earth as clinicians when we’re talking about what we think is necessary and what the unmet need is. The only caveat I would put forward is that clearly patient organisations need to work together and they need to have spokespersons who are able to formulate the questions and to also to reflect the views of all of the patients involved in those organisations because there is – as in everything else in life- the potential for people to be sometimes slightly radical in their views and that can also be counterproductive. So it is a balanced approach. But I hope you can see from what I have said that I feel this approach is a modern, effective way of moving forward, as the Secretary- General of the EAU, having just been re-elected, over the next four years of my term, I am going to make sure this is implemented in a every area of our activity.
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