Fearon David, Hughes Sean, Brearley Sarah G
International Observatory on End of Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster, UK.
Cairdeas International Palliative Care Trust, Mauritania, West Africa.
Br J Pain. 2018 Aug;12(3):183-188. doi: 10.1177/2049463717753021. Epub 2018 Jan 10.
The National Institute for Health and Care Excellence (NICE) promotes evidence-based medicine throughout contemporary health care. Its guidelines are employed in the United Kingdom and elsewhere, influencing the type and quality of health care provided. NICE considers a range of evidence in the process of creating guidelines; however, the research accepted as evidence greatly relies on positivist methodologies. At times, it is unnecessarily restricted to quantitative methods of data collection. Using the Clinical Guideline 140, opioids in palliative care, as an example, it is demonstrated that the research accepted as evidence is unable to provide answers to complex problems. In addition, several inherent biases are discussed, such as age inequality and pharmaceutical company influence. In order to provide coherent and useful guidelines relevant to complex problems in a real world setting, NICE must move away from focusing on data from randomised controlled trials. Its epistemological foundation must be questioned, paving the way for alternative research paradigms to be considered as evidence and thereby enriching subsequent guidelines.
英国国家卫生与临床优化研究所（NICE）在当代医疗保健领域推广循证医学。其指南在英国及其他地区得到应用，影响着所提供医疗保健的类型和质量。NICE在制定指南的过程中会考虑一系列证据；然而，被视为证据的研究很大程度上依赖实证主义方法。有时，它不必要地局限于定量数据收集方法。以临床指南140《姑息治疗中的阿片类药物》为例，结果表明被视为证据的研究无法为复杂问题提供答案。此外，还讨论了一些内在偏见，如年龄不平等和制药公司的影响。为了在现实世界背景下提供与复杂问题相关的连贯且有用的指南，NICE必须不再专注于来自随机对照试验的数据。其认识论基础必须受到质疑，为将替代研究范式视为证据并进而丰富后续指南铺平道路。
