Patient choice and evidence based decisions: The case of complementary therapies.
OBJECTIVE
Current government policies simultaneously pursue the development of 'patient-led' and 'evidence-based' approaches to healthcare. The objective of this study was to explore how primary care clinicians and Primary Care Trust (PCT) managers balance these potentially competing tensions when considering popular, controversial treatments, like complementary therapies, in consultations (clinicians) or funding decisions (PCT managers).


METHODS
We selected two case sites where complementary therapies were offered on NHS premises in England. We interviewed 18 PCT managers and clinicians, conducted an observation of a PCT meeting on complementary therapies and collected documentary data from referral databases and service funding bids. All interviews were taped, transcribed and analysed thematically. Interview, observation and documentary data were used to compare reported beliefs and behaviour to observed and documented behaviour.


RESULTS
The majority of clinicians and PCT managers claimed that research evidence guided their decisions; those who did not felt increasingly marginalized. However, discrepancies between reported and observed behaviour suggest that perceptions of research evidence, rather than fact based knowledge, predominated when considering complementary therapies.


CONCLUSIONS
In the case of NHS complementary therapy service provision, patient preference may be largely insignificant in clinician and PCT managerial decisions, with decisions based mainly on 'evidence rhetoric' devised from collectively agreed, unchallenged, tacit perceptions of research literature. If a patient-led NHS is to become a reality, NHS professionals need to cede the power that they wield with evidence rhetoric and acknowledge the legitimacy of patient preferences, views and alternative sources of evidence.
Wye
Lesley
L
Academic Unit of Primary Health Care, University of Bristol, Oakfield Grove, Bristol, UK. lesley.wye@bristol.ac.uk
Shaw
Alison
A
Sharp
Debbie
D
D000328:Adult; D001291:Attitude of Health Personnel; D002755:Choice Behavior; D000529:Complementary Therapies / Q000706:statistics & numerical data*; D003657:Decision Making; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D013222:State Medicine; D006113:United Kingdom