Institute for Evidence-Based Healthcare: Integrity, Impact, Innovation

ABOUT US

Established in 2010 as the Centre for Research in Evidence-Based Practice (CREBP) we have now transitioned into the Institute for Evidence-Based Healthcare in 2019. The transition from Centre to Institute will give us greater ability to deliver research and services related to the provision of sustainable, evidence-based healthcare and how research can greater influence policy and practice. The transition will also help us to increase our impact, partnerships, and translational project opportunities, as well as new educational programs.

The Institute will continue to deliver world-class research, engagement and training that will serve as a national and international resource for scholars, clinicians, system leaders, patients and families in the implementation of evidence-based clinical care. The effective integration of research into practice will contribute to the health and healthcare of Australians and influence health policy, improve global health outcomes and continue to enhance Bond University as a leading private and independent University.

Our research focus will continue to address big, neglected problems in healthcare. This will assist health systems to provide care that is patient-centred and informed by evidence, and will enable patients to make decisions that are congruent with their values, preferences and circumstances.

Warm Regards, Professor Paul Glasziou Director, Institute for Evidence-Based Healthcare

TA B L E O F C O N T E N T S Our purpose

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Centre for Research in Minimising Antibiotic Resistance in the Community (CRE-MARC)

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Overdiagnosis

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Research alliance forms to deal with overdiagnosis

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Expanding disease definitions

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Impact by numbers

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Shared decision making

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Study finds nearly half of prostate cancers in Australia are overdiagnosed

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Improving the uptake of evidence into clinical care

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Effective non-drug treatments

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Bond researchers discover healthy habits the key to ‘no diet’ diet

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There’s an app for that

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A call for the restraint on the use of aggressive treatments for elderly people dying of natural causes

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Workshops

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Bond University Sustainable Healthcare Awards

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Our work and collaborations

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Worldwide collaborations

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7th International Scientific Conference on Preventing Overdiagnosis

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Master of Healthcare Innovations

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Health Sciences & Medicine at Bond University

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Contract and advisory services

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Top 10 papers

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Support our work

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Meet our team

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OUR PURPOSE

We aim to improve healthcare by better understanding the causes of, and solutions to, gaps between research evidence and its application in practice.

TO ACHIEVE THIS , WE: • Undertake research that more closely aligns evidence and patient care; • Support and extend collaborations between clinicians and health researchers to achieve better value care; • Enable patients and families to make evidence-informed health decisions that are congruent with their values and preferences; • Lead and facilitate the teaching and learning of evidence-based practice; • Develop young researchers for research programs in sustainable healthcare.

To deliver these aims, we will generate new research evidence on four big neglected problems in healthcare.

Antibiotic resistance: which currently leads to 30,000 avoidable deaths per year in both Europe and the USA, threatening elective surgery, and a resurgence of the bacterial diseases of the 19th century.

Overdiagnosis: which has led to a massive increase in the apparent prevalence of many diseases through definition change and overdetection, causing much harm and rising healthcare costs.

Neglected non-pharmaceutical treatments: which are often as effective or more effective than their pharmaceutical cousins, but are poorly described, poorly ‘marketed’, and little used.

Waste in medical research: which we have estimated at costing over $100 billion per year resulting from avoidable design flaws, non-publication and poor reporting.

Centre for Research in Minimising Antibiotic Resistance in the Community (CRE-MARC)

Centre for Using Healthcare Wisely

Centre for EvidenceInformed Health Decisions Gold Coast Hospital Evidence-Based Practice Professorial Unit

Australian EQUATOR Centre

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CENTRE FOR RESEARCH EXCELLENCE

in Minimising Antibiotic Resistance in the Community (CRE-MARC) Antibiotic resistance currently causes 30,000 avoidable deaths per year in Europe and the USA, threatens elective surgery, and foreshadows a resurgence of the bacterial diseases of the 19th century, with primary care becoming a major contributor to the problem.

WHAT ARE WE DOING? There are five Research Streams: 1. Community antibiotic stewardship implementation studies with several Primary Healthcare Networks (PHNs) and Practice-Based Research Networks, culminating in a randomised trial of interventions known to be effective at reducing antibiotic prescribing; 2. Skin and soft-tissue infections (SSTIs) and urinary tract infections (UTIs) – generating and synthesising evidence about antibiotic benefits and harms for these conditions (which together with acute respiratory infections covers >85% indications for antibiotic use in primary care) and developing interventions to improve appropriateness of antibiotic use for them; 3. Residential aged care facilities – tackling the problem of very high antibiotic use by exploring the reasons and using information about enablers and barriers to design interventions that improve the appropriateness of antibiotic use; 4. GP registrars – developing and evaluating targeted educational interventions; and 5. Addressing other important, but neglected, questions about antibiotic resistance by conducting both primary studies and systematic reviews of the literature.

This research solidifies the Institute as one of Australia’s leading authorities on the issue of antibiotic resistance, labelled by the World Health Organization (WHO) as a key global health concern facing our generation.

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OVERDIAGNOSIS “The problem of overdiagnosis is part of the wider problem of too much medicine – which is essentially too much of a good thing, the team at Bond has developed an international reputation for trying to tackle this vexing challenge.”

Assistant Professor Ray Moynihan The team at the Institute has become a leader nationally and internationally in understanding and addressing the problem of overdiagnosis.

Overdiagnosis happens when people receive medical diagnoses that may do them more harm than good.

Along with work trying to understand the nature of the problem, and what’s driving it, the team has

initiated attempts to start taking action to address it and reduce the number of people being unnecessarily harmed. We have mapped some drivers and solutions, informed and consulted community members and developed a national response, that involves organisations across the healthcare landscape.

“We know harm can come from overdiagnosis... there is no doubt we need some sort of approach to address it.”

Professor Brendan Murphy Chief Medical Officer of Australia Sydney Morning Herald, 2018

DRIVERS AND SOLUTIONS

INFORMED COMMUNITY VOICES

In preparation for a national plan of response, a map of the possible drivers of overdiagnosis and its potential solutions was developed from the medical literature across five interrelated domains.

As the map shows, the key drivers include, but are in no way limited to:

We also know that often the people affected most by health policies and guidelines are not meaningfully consulted. When informed about the challenges of overdiagnosis and overtreatment, community members (those most directly affected by the health condition) may provide important and unique contributions to potential solutions.

• Cultural beliefs that more tests and treatments are better; • Financial incentives at the health system level; • Technological change enabling identification of smaller and more minor abnormalities; • Professional fear of missing disease and cognitive biases in decision making; and • Public expectations that clinicians will “do something”.

Our community engagement team has been working on methods to improve healthcare through our deliberative democracy research.

Australian researchers developed a collaboration to address overdiagnosis and overtreatment.

This alliance is the Wiser Healthcare research collaboration on overdiagnosis.

Possible drivers and potential solutions to overdiagnosis and related overuse POSSIBLE DRIVERS

POSSIBLE SOLUTIONS

CULTURE Beliefs; for example, more = better Faith in early diagnosis Intolerance of uncertainty Biased media reporting Medicalisation

INDUSTRY AND TECHNOLOGY Industry promotion Diagnostic test sensitivity Medicine as a business Industry expands markets

Ind

Culture

lth System Hea and Techn olo try s u s i o s e n als of Pr

gy

HEALTH SYSTEM Financial incentives Expanding disease definitions Quality measures Complexity of care Guidelines Screening

CULTURE Awareness / information campaigns Healthy scepticism about early diagnosis Address uncertainty Improve media reporting

Patients and Public

PROFESSIONALS Fear of litigation Fear of missing disease Flaws in training Lack of confidence or knowledge Over-reliance on tests PATIENT AND PUBLIC Over-reliance on tests Lack of confidence or knowledge Expectation clinicians will “do something”

HEALTH SYSTEM Reform incentives from quantity to quality Reform disease definition Reform quality measures Reform guidelines Reform screening More research on OD and OU Multicomponent inverventions INDUSTRY AND TECHNOLOGY Better regulate promotion Better evaluation of tests Declare, reduce, exclude COIs Better evaluate disease definitions PROFESSIONALS Reform litigation driver Comfort with uncertainty Educate and inform Interventions for providers Reduce test over-reliance PATIENT AND PUBLIC Shared decision making Education and information campaigns Promote “doing something”

Source: Pathirana T, Clark J, Moynihan R. Mapping the drivers of overdiagnosis to potential solutions. 2017. BMJ, 358: j3879.

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RESEARCH ALLIANCE FORMS TO DEAL WITH OVERDIAGNOSIS

Reversing the harms of overdiagnosis - “too much medicine” - is becoming a healthcare priority in Australia, prompting the formation of a new alliance of clinical, consumer, research and public organisations to tackle the problem.

Assistant Professor Ray Moynihan, a senior research fellow at the Institute, and colleagues, wrote that too many Australians were “receiving diagnoses unlikely to benefit them”.

“In 2016, for example, researchers estimated that over 500,000 people may have been overdiagnosed with thyroid cancer across 12 nations over two decades,” Moynihan and colleagues wrote.

“There is increasing recognition of the need for some form of coordinated national response to

develop evidence-informed strategies that can fairly and safely deal with the problem of overdiagnosis.”

“As a result, new relationships are being built between clinicians, researchers, stakeholders and decision makers around this counterintuitive health challenge, and a national response is emerging.”

Possible solutions include evidence-based public awareness campaigns, reformed system incentives to reward quality rather than quantity, better management of the problem of expanding disease definitions, better evaluation of the accuracy and utility of diagnostic tests, more professional education about overdiagnosis, and greater promotion of shared decision making.

Sources: bond.edu.au/news/59067/research-alliance-forms-deal-overdiagnosis Moynihan, R., Barratt, A.L., Buchbinder, R., et al., (2018). Australia is responding to the complex challenge of overdiagnosis. MJA, 209(8), 332-334.

E X PA N D I N G D I S E A S E DEFINITIONS New reform aims to prevent overdiagnosis and stop defining healthy people as diseased. Overdiagnosis can happen when the definitions of diseases are broadened so much that people with very mild problems, or people at very low risk of future illness, are classified as being sick, given a label, and then offered treatments which may do more harm than good.

Examples of the problem of inappropriately expanded definitions of disease include: • The controversial definition of chronic kidney disease, which labels many older people who will never experience related symptoms, was launched at a meeting sponsored by a drug company.

• A vastly expanded definition of gestational diabetes, which may now label up to one in five pregnant women, despite a lack of good evidence that the newly labelled women or their babies will gain meaningful benefits that outweigh potential harms.

• A proposal to expand the definition of high blood pressure, which would label one in every two adults in the US, but has been rejected by a family doctor organisation and others over concerns it may cause more harm than good to many people.

• The creation of “pre-diseases” such as preosteoporosis, or pre-diabetes, which classify healthy people who are essentially ‘at risk of being at risk’.

WHAT ARE WE DOING ABOUT IT? This new proposal recommends replacing existing panels with much more multi-disciplinary panels, with representatives from consumer / citizen organisations, led by generalists, with all members free of financial ties to pharmaceutical or other interested companies.

It aims to change the rules for defining disease and setting thresholds for medical diagnoses.

Source: (Moynihan, R., Brodersen, J., Heath, I., ... Glasziou, P. (2019). Reforming disease definitions: a new primary care led, people-centred approach. BMJ EBM, doi:10.1136/bmjebm-2018-111148)

“Winding back unnecessary tests and treatments, unhelpful labels and diagnoses won’t only benefit those who directly avoid harm, it can also help us create a more sustainable future.”

Dr Fiona Godlee Editor-in-chief, BMJ

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Shared D ecision Makin g visitin g international researchers

7 Decision Aids for patients PAGE 12

SINCE 2017

I M PAC T BY N U M B E R S

>30

events

Antibiotic Resistance Causin g

30,000 avoidable deaths PAGE 4

450 workshop atten dees

PAGE 24

+ Million

grant funding

2 WEEK SYSTEMATIC REVIEW SAVING

90% TIME PAGE 37

p eer reviewed publications

HANDI

Preventing Overdiagnosis

65 entries 130,0 0 0 page views

International Conferences

PAGE 20

SYSTEMATIC REVIEW ACCELER ATOR

3 ,776 users 45 , 607 page views

(2013 - 2019)

PAGE 32

85% WASTE

IN RESEARCH costing $100 billion per year

PAGE 37

TESTING TREATMENTS

TIDieR Repor ting Guideline

(BOOK)

1,500 citations 3 translations

20 translations 100,000 downloads

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SHARED DECISION MAKING

WHAT IS SHARED DECISION MAKING AND WHY IS IT IMPORTANT? Overuse of low-value healthcare and underuse of effective healthcare are deeply entrenched. Both represent suboptimal care. Their drivers include: cognitive biases, poor communication, knowledge uncertainty, and structural and financial elements of health systems. Health systems are now striving to provide appropriate care, which can be described as care that is patient-centred and where the benefits and harms are weighed up and informed by evidence.

A key strategy to achieving this is shared decision making - a process which enables patients to make evidence-informed health decisions that are

congruent with their values and preferences, after collaborative deliberation with their clinician. Genuine patient involvement in making informed health decisions is a fundamental right. As well as benefitting individual patients and clinicians, shared decision making holds promise for protecting and improving the health of populations and contributing to health system sustainability by reducing the overuse of ineffective tests and treatments and increasing the uptake of effective ones. It is a key component of most healthcare reform models and policies to emerge in recent years. Strategies that can be used to facilitate shared decision making include the use of patient decision aids, clinician training, and the integration of shared decision making tools into evidence syntheses such as guidelines.

Optimal Patient Care

Shared Decision Making

Evidence-based Medicine

Patient-centered Communication Skills

The Interdependence of Evidence-Based Medicine and Shared Decision Making and the Need for Both as Part of Optimal Care

(Source: Hoffmann, T.C., Montori, V.M., Del Mar, C. (2014).

The connection between evidence-based medicine and shared decision making. JAMA, 312(13), 1295-1296)

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HELPING TO FA C I L I TAT E SHARED DECISION MAKING Research activities of the Centre for Evidence-Informed Health Decisions include the development and dissemination of patient decision aids and the development of online and interactive training courses in shared decision making. These courses enable clinicians of any discipline to complete an accredited training activity at a time and location that is convenient to them – thus overcoming some of the barriers to shared decision making uptake.

The courses have been adopted by health organisations and various speciality colleges throughout Australia and the United Kingdom.

Middle ear infection: should my child take antibiotics?

• This decision aid is to help you decide whether to use antibiotics when your child has a middle ear infection.

• This can help you to talk and make a shared decision with your doctor about what is best for your child.

What causes middle ear infection?

How long does the earache last?

• It can be caused by a viral or bacterial infection. It is hard for your doctor to tell which it is.

• It is also called ‘acute otitis media’. Acute means it is a short-term infection.

• Symptoms (such as earache) usually get better in 2 to 7 days, without antibiotics.

What are the treatment options?

There are 2 options that you can discuss with your doctor: 2. Taking antibiotics 1. Not taking antibiotics

This means letting the infection get better by itself.

Symptoms, such as pain and fever, can be treated with over-the-counter medicines.

They can be used with either option.

What are the likely benefits and harms of each option?

WITH ANTIBIOTICS

Average length of middle ear infection Average reduction in length of infection

Children who take antibiotics have the earache for only about 12 hours less than children who do not.

12 Hours

infection lasts about 72 hours (3 days)

WITHOUT ANTIBIOTICS infection lasts about 84 hours (3.5 days)

0

1

DAYS

2

3

4

These figures show what happens to children with middle ear infection who do not take antibiotics and those who do. Each circle is one child. We can’t predict whether your child will be one of the children who is helped or harmed. gets better by 2-3 days gets better by 2-3 days due to antibiotics not better by 2-3 days 100 children who don’t take antibiotics

100 children who

do take antibiotics

89

84

has problems has problems due to antibiotics no problems 100 children who don’t take antibiotics

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100 children who

do take antibiotics

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Will be better (no pain) at 2-3 days

Will have problems, such as vomiting, diarrhoea or rash

Not better

80 No problems 73

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With antibiotics, 5 more children will be better after 2-3 days.

After about 4 days most children will be better anyway without antibiotics.

With antibiotics, 7 more children will have problems like vomiting and diarrhoea. Other antibiotic harms are: - the cost of buying them - remembering to take them - the risk of antibiotic resistance (see next page)

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Study finds nearly half of prostate cancers in Australia are overdiagnosed An Australian-first study led by the Institute has found that at least 41% of prostate cancers detected by commonly performed screening tests are overdiagnosed. Dr Pathirana and colleagues did this by looking at the lifetime risk comparing 1982 to 2012.

They found that 41% of currently detected prostate cancers would never have become apparent in 1982 – they were ‘overdiagnosed’.

From autopsy studies we know many men die of other causes with dormant and undetected prostate ‘cancers’ - around 50% of men aged 70.

Those men were certainly better off not having their prostate cancer detected before they died of something else.

The Figure below sets out these numbers: in a lifetime, of 100 men, three die of prostate cancer,

50 30 8 9 3

No prostate cancer Dormant cancers not detected during screening Dormant cancers detected during screening (overdiagnosed) Develop non-fatal clinical prostate cancer Die of prostate cancer

Source: Pathirana, T., Hayen, A., Doust, J., Glasziou, P. and Bell, K., 2019. Lifetime risk of prostate cancer overdiagnosis in Australia: quantifying the risk of overdiagnosis associated with prostate cancer screening in Australia using a novel lifetime risk approach. BMJ open, 9(3), p.e022457.

nine others are found with prostate cancer that causes symptoms but do not die; eight are detected with dormant cancers that never would have caused a problem, and 30 more could have it detected at autopsy but never would have had symptoms nor known they had prostate cancer.

This all creates a dilemma for screening.

If we screen more we might save one of the three men, but we will also overdetect and treat men with surgery and / or radiation who never would have had a problem. A few years ago we asked a community ‘jury’ of men - who spent a weekend going over the pros and cons - whether we should have a prostate screening program. They said no, but we should better educate GPs to inform their male patients about these pros and cons so they can make up their own minds.

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E VID E N CE- BAS PROFESSO

I M P R O V I N G T H E U P TA K E O F EVIDENCE INTO CLINICAL CARE Our Evidence-Based Practice Professorial Unit at Gold Coast University Hospital aims to ensure all healthcare workers are skilled users of research. The Unit is a joint initiative between Bond University and the Gold Coast Hospital and Health Service. They operate on the principle that the incorporation of the best evidence in routine clinical care leads to the best outcomes for patients.

Improving the uptake of evidence into clinical care is supported by the delivery of training workshops in evidence-based practice, protocol writing, systematic reviews and knowledge translation.

Leaders in research

Participants in research

Users of research

Degree of involvement in research

SED PRAC TICE RIAL UNIT

WHAT WE DO • Embedding high quality clinical research as part of routine care • Expert panel review of research proposals • Policy and guidelines review and advisory services • Training workshops • Building staff and student research capability, education, coaching and mentoring • Building a sustainable culture of evidence-based practice • Enhancing research activity and productivity

• Developing shared decision making aids for clinicians and patients • Reducing overdiagnosis and overtreatment • Deprescribing at end of life • Reducing low-value care • Conducting systematic reviews, meta-analysis and biostatistics • Minimising antibiotic resistance

Contact us: Evidence-Based Practice Professorial Unit, Bond Research and Education, Level 2, Pathology and Education Building, Gold Coast University Hospital, QLD 4226 – EBP_unit@bond.edu.au in collaboration with

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EFFECTIVE NON-DRUG T R E AT M E N T S Non-drug treatments (exercises, procedures, self-management, etc.) are often as effective and as safe, or safer than their pharmaceutical cousins but are poorly described, poorly ‘marketed’, and therefore little used.

In 2013 we initiated, with the Royal Australian College of General Practitioners (RACGP), the Handbook of Non-Drug Interventions (HANDI) that mirrors existing pharmacopoeias, including indications, contraindications and ‘dosing’,

and aims to make ‘prescribing’ a non-drug therapy as easy and precise as writing a prescription. We are doing further research in three areas: (A) systematic reviews and / or trials of potential new non-drug treatments for HANDI; (B) Better uptake of the existing evidence-based treatments in HANDI; and (C) Development and evaluation of patient versions to enhance treatment fidelity and enable decision aids.

The topics in HANDI have been developed by the HANDI Project team and is supported by appropriate evidence. racgp.org.au/handi

BOND RESEARCHERS DISCOVER H E A LT H Y H A B I T S T H E K E Y T O ‘NO-DIET’ DIET became second-nature, like putting on your seatbelt when you get in the car.

After 12 weeks, participants in both groups lost an average of 3.1 kilograms. Most surprising was that one year after the programs had finished, participants continued to lose a further 2.1 kilograms on average, reducing their total body weight by 5%.

An internet search for ‘diet for weight loss’ comes back with nearly 51 million results; yet, no matter which diet you choose to follow, the evidence shows the majority of these diets will not help you achieve your weight loss goals long-term. Researchers from Bond University have demonstrated that the real way to shed the pounds and keep them off is to simply maintain a few healthy habits.

It might sound too good to be true; a weight lossregimen that keeps the kilos off without a punishing diet. The method is surprisingly simple.

Lead researcher, Dr Gina Cleo, found that simply changing small habits resulted in not just weight loss, but long-term weight loss maintenance.

The researchers randomised volunteers aged 18 - 75, who were classified as overweight or obese, into three groups and each were given a different program to complete.

One program promoted breaking old habits, one promoted forming new habits and one was a waitlist control group.

The habit-breaking group was sent a text message with a different task to perform every day, focused on breaking usual routines and not necessarily on diet and exercise. Tasks included things like ‘drive a different way to work today’, or ‘listen to a new genre of music’.

The habit-forming group was asked to follow a popular ‘Ten Top Tips’ program which focused on building new healthy lifestyles.

Dr Cleo says her team’s research demonstrates how diet and exercise are not the only elements of a weight loss program but that changing habits is also an important factor.

“95% of weight loss attempts fail and most diets show no long-term effects. There’s a general trend of regaining about 50% of the weight lost in the first year after losing it and much of the rest is gained in the following couple of years,” says Dr Cleo.

“Because habits are ingrained in our daily life, they are resistant to change. When our intentions and our habits are in conflict, our habits will generally win.

Therefore, understanding our own habits, and more importantly, understanding how to change them is very important.”

“Studies now show – and my study confirms – that weight loss maintenance can and has been achieved with habit-based programs. These programs aren’t focused on diet and exercise but rather on our subconscious behaviours, which control about 45% of our daily actions.”

Director of the Institute, Professor Paul Glasziou, says the study is a milestone in weight loss research.

“If this ‘simple habits’ approach was a pill, we’d be very rich.”

“Weight loss diets are mostly yo-yos – loss then regain – whereas this ‘changing habits’ approach provides a steady long-term, loss,” says Glasziou.

Some of the tips include: ‘eat from a smaller plate’, and ‘eat more mindfully’. The group were encouraged to incorporate the tips into their daily routine, so they 21

There’s an app for that From losing weight to quitting smoking and monitoring chronic conditions, there is no shortage of health apps on Apple and Google stores that promise to make you healthy. But should we be entrusting our health to these free, advertisement-riddled smartphone applications?

“Imagine going to your primary care physician with something that’s been annoying you for a while and they suggest an evidence-based app instead of pills or potions as usual. I for one would like that.”

This question was one that sparked the research of PhD student, Dr Oyuka Byambasuren, who has been investigating the effectiveness and practicality of health and medical apps since 2016.

This is where the free-market approach of the app store means health and fitness apps are largely unregulated and the developers want to skip over the testing part because they are benefiting from the hypedriven market.

“We all know the famous phrase: ‘There’s an app for that’. I was wondering if they were truly any good and if they were, should we be using them in medical practice?” says Dr Byambasuren.

When Dr Byambasuren started her research there were about a quarter of a million apps in the medical, health and fitness categories of the app stores, meaning it was impossible for her to comb through every single one and find studies or trials that the app might have been a part of.

Instead, Dr Byambasuren’s study focused on the research literature.

“We proposed that, if shown effective in improving health outcomes, stand-alone apps could be officially ‘prescribable’ by a medical professional as a nonpharmaceutical intervention,” says Dr Byambasuren.

The main hurdle of this approach was what Dr Byambasuren calls ‘digital exceptionalism.

“But when it comes to health, we believe that any app that claims to improve your health should be backed by evidence,” says Dr Byambasuren.

While overseas bodies like the National Health Service in the UK are taking proactive steps to build a medical app library, Dr Byambasuren says no similar body in Australia has plunged into the deep end and taken responsibility for the tsunami of health apps on the market which claim to help patients.

“Apps can be really helpful for behaviour change, which is a challenging aspect of medicine,” she says.

“But it isn’t strong enough alone; it needs good quality evidence in the medical profession.”

“Apps can be really helpful for behaviour change, which is a really challenging aspect of medicine.

But it isn’t strong enough alone.”

A CALL FOR THE RESTRAINT ON THE USE OF AGGRESSIVE T R E AT M E N T S F O R E L D E R LY PEOPLE DYING O F N AT U R A L CAUSES

As medical technology and public health developments enable us to live longer, the proportions of those aged 70 years and above is growing, leading to a swelling and unsustainable demand for health services to manage the increased prevalence of irreversible age-related chronic illnesses. Unfortunately, sometimes aggressive treatments are administered to older people which will cause more suffering than benefit and prolong dying rather than improve the quality end of life.

Our research program on end-of-life aims to create awareness among health professionals in Australia and overseas of the extent of non-beneficial treatments administered to older patients with multiple chronic conditions who are in their last months of life.

“I have no interest in the quantity of my life; I have every interest in the quality” Female, Organic dementia

Associate Professor Magnolia Cardona

We have designed and validated a risk prediction tool to enhance prognostic certainty for clinicians, and have identified quantifiable indicators of low-value care and non-beneficial interventions that can be monitored by health services. We are designing and testing electronic decision support to enable informed choices involving clinicians and patients in the process. Our initiatives extend to the health service consumers, investigating patients’ and their informal caregivers’ perspectives and priorities, and informing them of wiser treatment options and the need to minimise demand for low-value services. Our systematic reviews have built evidence to inform clinical practice that prevents harm, and ultimately prevent unnecessary suffering from the medicalisation of dying.

“No-one is allowed to die anymore … it has almost become a dirty word” NSW doctor

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Interested in attending one of our workshops? “The Knowledge Translation (KT) workshop was a great way to gather a team of colleagues to focus on a specific KT project.

Having an implementation coach sit at our table helped us progress markedly further than I had hoped. The course was a great balance of theory and practical application to the specific project.�

KT Workshop Participant

SYSTEMATIC REVIEWS This workshop provides an introduction to systematic reviews and is aimed at clinicians and researchers who want to understand how to use and conduct a systematic review. It covers the structure of a systematic review, how to critically appraise the quality of a review, search strategies, and interpreting the results of a systematic review.

PRACTISING KNOWLEDGE TRANSLATION This three-day workshop is aimed towards practising clinicians, healthcare administrators, healthcare leaders or academics interested in learning how to take evidence from their desktop to the real-world; healthcare teams charged with rolling out evidence-based interventions, who are unsure how to do it in a structured and evidence-based way or practitioners implementing a healthcare change who are unsure how best to evaluate the outcomes.

PROTOCOL DEVELOPMENT This two-day workshop aims to take researchers from a research question to a complete study protocol.

PUBLICATION SCHOOL: THE SECRETS OF SUCCESS IN WRITING AND PUBLISHING RESEARCH ARTICLES This two-day workshop aims to develop essential writing skills to help achieve success in planning, writing, publishing, and communication research through traditional journals and other channels.

NAVIGATING THE EVIDENCE MAZE: BETTER SEARCHING, SIFTING, AND CRITICAL ANALYSIS OF RESEARCH Evidence-based practice (EBP) is the cornerstone of an effective and efficient healthcare system. Objectives for this workshop are to formulate a clinical or research question; find the evidence; appraise a research paper; understand research outcomes; close the loop between research and practice; demystify the statistics; interpret the numbers; apply statistics to clinical practice.

For more information or enquiries, please contact our Institute Manager, Assistant Professor Chrissy Erueti at iebh@bond.edu.au.

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AWARDS SPONSORS

SUSTAINABILITY OF HEALTHCARE AWARDS AND COLLOQUIUM Join inspiring healthcare leaders at the annual Bond University Sustainability of Healthcare Awards and Colloquium. The colloquium will include a daytime session beginning at 1pm, featuring international keynote speakers, as well as interactive forums and discussion panels debating causes and solutions for overdiagnosis, overtreatment and the sustainability of healthcare. The awards raise awareness of best practice in high value healthcare and recognising and promoting the achievements of those in the healthcare community and consumers who are leading the way to create positive change in this area.

AWARD CATEGORIES Thanks to the support of our sponsors, each award category winner will receive a $5,000 bursary to use towards their sustainable healthcare project.

• • • • •

Health Literacy Award – For increasing public understanding of sustainable health Practice Award – For sustainable health intervention that is being implemented Research Award – For increasing understanding of causes or interventions for sustainable health Educational Award – For increasing understanding in students of sustainable health Policy Award – For driving improvements at a regional or national level

All nominees and award winners will be recognised at the event for their contribution to sustainable healthcare, and winners will be given the opportunity to showcase their submission to the wider audience.

CALL FOR SUBMISSIONS For information on call for submissions, please visit bond.edu.au/sustainable-health-care or email hsmevents@bond.edu.au.

EVENT DETAILS You can purchase tickets to attend the Colloquium from 1pm - 5pm and / or the Dinner and Awards 5.30pm - 9pm.

For further information, please visit bond.edu.au/sustainable-health-care or email hsmevents@bond.edu.au

bond.edu.au CRICOS Provider Code 00017B Information is correct at time of printing (July 2019).

2 0 1 8 S U S TA I N A B L E H E A LT H C A R E AWA R D W I N N E R S

Awards recognise Australia’s leading sustainable healthcare pioneers and advocates

The research team behind a trial of 24-hour emergency nursing care at Southport Watchhouse has won one of five major awards at the inaugural Bond University Sustainable Healthcare Awards.

The Award winners were announced on 22 November, 2018 during a dinner at the Bond University Club on the Gold Coast. The Awards were developed and launched in 2018 to raise awareness of best practice in high-value healthcare and recognise the achievements of advocates and pioneers in this area.

Sustainable Healthcare aims to improve health outcomes while using resources wisely. Sustainable health interventions should be evidence-based, effective, minimise waste, affordable and able to be implemented in the long-term without accumulating adverse consequences for society or individuals.

In addition to the Research Award (outlined above) the other major award winners were: Health Literacy Award: For increasing public understanding of sustainable health (sponsored by Bupa Health Insurance) - WINNER: Health Lit for Kids Practice Award: For sustainable health intervention that is being implemented (sponsored by Concerto Analytics) - WINNER: Choosing Wisely Australia Educational Award: For increasing understanding in students of sustainable health (sponsored by HealthCert) - WINNER: 12 Month Redesign Program - Graduate Certificate (Clinical Redesign) Policy Award: For driving improvements at regional or national level (sponsored by Osler Technology) WINNER: Wiser Healthcare

Professor Julia Crilly of Griffith University claimed the Research Award: For increasing understanding of causes or interventions for sustainable health (sponsored by Health Service 360) - on behalf of the Gold Coast Health and Griffith University team.

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Our work and collaborations The EQUATOR Network is an international initiative that seeks to improve the reliability and value of published health research literature by promoting transparent and accurate reporting and wider use of robust reporting guidelines. In addition to helping carry out the strategic vision of the EQUATOR Network in Australia and the Asia-Pacific region, the focus of the Australasian EQUATOR Centre is on reducing waste and enhancing the value of biomedical research. equator-network.org “The EQUATOR mission is to achieve accurate, complete, and transparent reporting of all health research studies to support research reproducibility and usefulness. Our work increases the value of health research and helps to minimise avoidable waste of financial and human investments in health research projects.”

Wiser Healthcare is a group of collaborating researchers based in Australia. They were awarded to related grants from the National Health and Medical Council at approximately the same time: a $2.5 million Centre for Research Excellence award (running from June 2016 to May 2021) and a $10 million Program Grant (running from January 2017 to December 2021). They decided to join forces to maximise the productivity of both grants. wiserhealthcare.org.au “We aim to conduct research that will reduce overdiagnosis and overtreatment in Australia and around the world.”

The Centre for Evidence-Based Medicine aims to develop, teach and promote evidence-based healthcare through a variety of methods so that all healthcare professionals can maintain the highest standards of medicine. cebm.net

The NHMRC Partnership Centre for Health System Sustainability brings together researchers, policy makers, providers, clinicians and consumers from across the nation to find strategies to ensure our health system delivers valuebased care to our citizens well into the future.

We believe that an effective and efficient health system is the hallmark of a caring, well-functioning society. healthsystemsustainability.com.au “Our vision is that our research findings significantly influence the evolution of a resilient healthcare system that is affordable, cost-effective and delivers improved health outcomes for all Australians over time.�

The Reward Alliance

This website is a place to share and exchange documentation, information, and resources on how to increase the value of both basic and applied research and reduce or avoid wasting research. rewardalliance.net

Our mission is to lead, strengthen and support collaboration in guideline development, adaptation and implementation. As a major player on the global healthcare quality stage, G-I-N facilitates networking, promotes excellence and helps our members create high quality clinical practice guidelines that foster safe and effective patient care. g-i-n.net

International Society for Evidence-Based Health Care.

The mission of the Society for Evidence-Based Health Care is to develop, and encourage research in, the appropriate usage of evidence in health care decision making and to promote and provide professional and public education in the field. isehc.net 29

EUROPE

Worldwide collaborations CANADA Ottawa Canadian EQUATOR Centre Toronto Professor Sharon Straus, Knowledge Translation Program, University of Toronto

USA New Hampshire Dartmouth College, Preventing Overdiagnosis Conference Partner Bethesda National Cancer Institute Minnesota EBP Center, Mayo Clinic, Rochester

International Collaboration for the Automation of Systematic Reviews (ICASR) ICASR is a global network of with 50+ members from eight countries who are interested in the automation of systematic reviews, which we coordinate. The current steering group for the collaboration includes members from NIEHS (NIH), Cochrane, UCL, Institute for EvidenceBased Healthcare (Bond University), and several other organisations. icasr.github.io

United Kindom Oxford • UK EQUATOR Centre • The Centre for EvidenceBased Medicine, Preventing Overdiagnosis Conference Partner

France Paris French EQUATOR Centre

Sweden Cochrane Sweden Norway EBRNetwork. Professor Hans Lund, Western Norway University of Applied Sciences

Denmark Copenhagen The University of Copenhagen, Preventing Overdiagnosis Conference Partner Netherlands Amsterdam Prof Patrick Bossuyt, University of Amsterdam Germany • Frankfurt Dr Christiane Muth, Johann Wolfgang Goethe University • Berlin Guidelines International Network Headquarters

AUSTRALIA Sydney • University of Sydney, Wiser Healthcare, Program Grant • University of Wollongong, Wiser Healthcare, Program Grant • Macquarie University, NHMRC Partnership Centre

JAPAN Tokyo St Luke’s Hospital

Melbourne • Monash University, Wiser Healthcare, Program Grant • Australasian Cochrane Centre • Therapeutic Guidelines Limited Gold Coast

• Institute for Evidence-Based Healthcare, Bond University • Australasian EQUATOR Centre, IEBH, Bond University • Gold Coast Hospital and Health Service

MALAYSIA Kuala Lumpur Associate Professor Liew Su-May, University of Malaysia

NEW ZEALAND Auckland Professor Rod Jackson, University of Auckland

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7th International Scientific Conference on Preventing Overdiagnosis Wiser Healthcare is excited to announce that they will be hosting the 7th international Preventing Overdiagnosis scientific conference in Sydney, 5 - 7 December, 2019. Bringing some of the world’s leading experts on overdiagnosis to Australian shores, this event promises to be an exciting, mind-stretching exploration of what’s causing overdiagnosis, where and how it’s happening, and what we can do about it. Conference themes are: • Commercial Drivers of Overdiagnosis / Commercial Determinants of Health • Genomics / Precision Health / AI • Overdiagnosis and the Media • Addressing Overdiagnosis and Overtreatment in Musculoskeletal Conditions • Screening and Overdiagnosis in the Asia-Pacific Region This news launches with some exciting keynote speakers already confirmed, including one of the world’s most influential editors, BMJ Editor in Chief Dr Fiona Godlee,Associate Professor Anna Stavdal (WONCA), Dr Barry Kramer from the US National Cancer Institute and Professor Adam Elshaug, world expert on health policy and low-value care.

In the past few years the conference has been presented all around the world: Copenhagen (2018), Québec City (2017), Barcelona (2016).

Co-Sponsored by the

Conference Partners

Associate Partners

preventingoverdiagnosis.net

MASTER OF HEALTHCARE INNOVATIONS CRICOS Course Code 099578F Duration: 1 year full-time (3 semesters per year) Starting: January, September The Master of Healthcare Innovations is an innovative and ground-breaking new degree, designed to empower the healthcare leaders of tomorrow to create positive, lasting change to the health system.

The Healthcare Innovations program will be run in conjunction with Bond’s Institute for Evidence-Based Healthcare, Bond Business School and the Bond Transformer. This emphasis on interdisciplinary and inter-industry learning and collaboration ensures the future graduates of this program can create a shift in current models and systems of care.

The program is designed for doctors, nurses, allied health professionals, health administrators, academics, and health journalists who want to problem solve clinical challenges within their local or larger health systems.

Offered full-time and part-time, Bond’s Master of Healthcare Innovations program will be delivered to small cohorts via a range of teaching methods including intensive workshops, collaborative online teaching sessions, design thinking exercises and podcasts, ultimately catering for interstate or international students, and those balancing studies with work and other commitments.

PROFESSIONAL OUTCOMES The program will develop graduates’ abilities to innovate, influence and implement a more effective, efficient and sustainable health system to meet the healthcare needs of the 21st Century. Graduates will be guided to diagnose a health system problem, apply critical and design thinking, and quality research evidence to an innovation project.

ALTERNATE STUDY OPTIONS The Healthcare Innovations program includes the following postgraduate degrees: • Graduate Certificate of Evidence Based Practice • Graduate Certificate of Health Systems • Graduate Diploma of Healthcare Innovations ACADEMIC REQUIREMENTS A minimum bachelor level degree in Health or a related program, or a minimum bachelor level degree in a non-health related area plus three years’ relevant work experience.

FURTHER INFORMATION More information can be found at bond.edu.au/MHI.

Students must complete the following eight required subjects, as well as three elective subjects.

REQUIRED Evidence Based Practice and Policy Find, critically appraise and apply research evidence to population, community and individual health needs.

Health Systems: Australia and International Consider socioeconomic contexts, organisational frameworks and funding arrangements of health systems.

Knowledge Translation and Quality in Health Care Develop your knowledge and skills to translate research evidence into clinical practice to improve health outcomes.

Educating the Health Workforce in the 21st Century Explore different models for educating and developing the health workforce.

Sustainable Health Care Understand and improve the quality of healthcare in a sustainable manner.

Managing People Understand, predict and influence behaviour in organisations.

Leadership and Technology Innovation in Health Management Explore how to lead strategic technological innovation.

Capstone Placement and Project Apply what you have learnt to a local, national or international project of your interest.

ELECTIVES • • • •

Generating Evidence Using Research Methods Systematic Review Planetary Health Entrepreneurship and Innovation

• • •

Health Analytics and Data Management Project Innovation and Change Silicon Valley Study Tour* * Enrolment into this subject requires Program Director approval and additional costs.

Office of Future Students

bond.edu.au CRICOS Provider Code 00017B Information is correct at the time of printing (September 2019).

Bond University Gold Coast Queensland 4229 Australia

Toll free: 1800 074 074 Phone: 07 5595 2222 bond.edu.au/enquire

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H E A LT H S C I E N C E S & M E D I C I N E AT BOND UNIVERSIT Y Bond University’s Faculty of Health Sciences & Medicine is dedicated to shaping professionals who are distinguished, not just by their superior scientific clinical skills, but by their ethics, compassion and humanity.

GLOBAL TOP

2

UNIVERSITIES

in the Times Higher Education (THE) Rankings of the Best Small Universities in the World in 2018

#1

The Faculty is committed to producing career-ready graduates equipped to be the next generation of influencers and leaders in health, medicine and research.

The Faculty offers a unique learning experience in state-of-the-art facilities where students have access to high-tech laboratories, a simulated hospital and consulting rooms, and advanced sports science equipment frequently used by elite athletes.

UNDERGRADUATE

IN AUSTR ALIA FOR STUDENT EXPERIENCE rated on the Quality Indicators for Learning and Teaching (QILT) website

Bachelor of Biomedical Science CRICOS Course Code 063085B 2 years full-time

ACCELERATED

Bachelor of Exercise and Sports Science CRICOS Course Code 080641D 2 years full-time

DEGREES

Complete a standard bachelor’s degree in two years or a standard master’s in one year

Bachelor of Exercise and Sports Performance CRICOS Course Code: 0100510 2 years full-time Bachelor of Health Sciences CRICOS Course Code 063068C 2 years full-time Medical Program^ CRICOS Course Code 087932C and 087933B 4 years and 8 months full-time

8

GLOBAL NETWORK

Students from more than 80 countries worldwide

POSTGRADUATE Master of Healthcare Innovations CRICOS Course Code 099578F 1 year full-time

10:1

Master of Nutrition and Dietetic Practice CRICOS Course Code 089734D 2 years full-time Master of Occupational Therapy CRICOS Course Code 090670E 2 years full-time Doctor of Physiotherapy CRICOS Course Code of075478G ^The Medical Program is comprised two sequential degrees – the Bachelor of Medical Studies (BMedSt) and the Doctor of Medicine (MD). All students selected for entry into the Medical 2 years full-time Program will have to complete both the BMedSt and MD to be eligible for registration as a medical practitioner in any state or territory in Australia or New Zealand.

Lowest Student: Teacher ratio in Australia of 10:1

FIVE STARS 2019 GOOD UNIVERSITIES GUIDE • • • • • • • •

Overall Quality of Education Teaching Quality Learner Engagement Learning Resources Student Support Skills Development Student Retention Student Teacher Ratio

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CO NTR AC T AN D ADVISO RY SERVICES Our work covers a wide range of services, programs and activities that address big, neglected problems in healthcare. The Institute delivers world-class research, engagement and training and serves as a national and international resource for health system leaders, industry partners, scholars, clinicians, patients and families in the implementation of evidence-based clinical care.

EVIDENCE CHECKS Accelerated automated systematic reviews that provide a concise summary of evidence to answer specific questions

CONTRACT RESEARCH Research support services, expert panel review of research proposals and evidence review of treatments

ADVISORY SERVICES Evidence-based practice advice to inform health service planning, reviews of guidelines and policies

RESEARCH AND TRANSLATION Coaching and support services to develop and deliver research translation projects

SHARED DECISION MAKING Developing and testing decision aids for patients and clinicians

CONSUMER ENGAGEMENT Facilitating community juries and consultations to help inform decisions and service planning

MINIMISING LOW VALUE CARE

REDUCING OVERDIAGNOSIS AND OVERTREATMENT

EDUCATION Tailoring education services to build research capacity and healthcare innovation

Preventing unnecessary treatments, maximising the use of non-drug interventions and deprescribing at the end of life

Reducing unnecessary screening and testing and implementing evidence-based practice

COMMISSIONING A S Y S T E M AT I C R E V I E W Systematic reviews are considered the highest-level evidence to underpin clinical decisions, guidelines, and policy decisions because they synthesise all of the existing evidence that answers a specific question, using methods that are transparent and reproducible.

2 WEEK SYSTEMATIC REVIEW (2WSR) Systematic reviews (SR) are time- and resource-intensive to produce, taking on average 45 weeks to complete, and typically requiring five or more personnel. The team recently developed and successfully piloted a process for significantly accelerating this timeline by integrating the use of Systematic Review Automation tools with the expertise of four experienced systematic reviewers to complete a full systematic review in less than two weeks!

SYSTEMATIC REVIEW ACCELERATOR (SRA) The SRA is purpose-built to speed up multiple steps in the SR process. It is freely available for anyone to use. SRA tools assist with searching for citations, citation screening, and write-up of SR findings. Existing tools are being continually reviewed and refined, and additional tools are being developed. sr-accelerator.com

“SRA use increase every year, with 968 users and 12,095 page views in 2016, 1,632 users and 29,860 page views in 2017 and 3,776 users and 45,607 page views in 2018.�

Our work on automation of evidence synthesis is in collaboration with ICASR (International Collaboration for the Automation of Systematic Reviews). icasr.github.io 37

Top 10 papers Over the last five years we have published > 430 peer-reviewed articles in some of the top journals including The Lancet, JAMA, BMJ and PLOS One. Here is a selection of the papers published during this period that we are most proud of, or which we feel have been most influential:

Pathirana, T., Clark, J., Moynihan, R. (2017).

Mapping the drivers of overdiagnosis to potential solutions. BMJ, 358:j3879.

This review was based on a systematic search of the literature on the drivers of and solutions to overdiagnosis. It was undertaken as part of a wider plan to inform and develop Australia’s response to the challenge of overdiagnosis and related overuse. The mapping work developed a model of multi-layered drivers and solutions. It has been widely influential, informing both Australia’s response, and official policy on overdiagnosis of the World Organisation of Family Doctors.

Cleo, G., Glasziou, P., Beller, E., Isenring, E., Thomas, R. (2018). Habit-based interventions for weight loss maintenance in adults with overweight and obesity: a randomized controlled trial. International Journal of Obesity, 43: 374-383.

Beller, E., Clark, J., Tsafnat, G., et al. (2018).

Making progress with the automation of systematic reviews: principles of the International Collaboration for the Automation of Systematic Reviews (ICASR). Systematic reviews, 7(1), 77.

The majority of individuals who lose weight through diet and exercise, will regain the weight back. Conversely, habit-based interventions achieve successful, long-term, weight-loss maintenance. These novel outcomes caught worldwide media attention, featuring in 130+ media outlets, reaching over 7 million viewers and listed as Editors’ Choice for ‘The best of International Journal of Obesity 2018’.

This paper sets out the “Vienna Principles”, to guide and enable systematic review automation tools to be developed and integrated into toolkits to improve their interoperability and the efficiency of systematic reviews. The principles were written by an international group, the International Collaboration for the Automation of Systematic Reviews (ICASR) at its first meeting held in Vienna in October 2015. The group has continued to meet annually to discuss progress, and move forward from the principles to active collaboration.

Del Mar, C. B., Scott, A. M., Glasziou, P. P., Hoffmann, T., van Driel, M. L., Beller, E., et al.

(2017). Reducing antibiotic prescribing in Australian general practice: time for a national strategy. MJA, 207(9), 401-406.

This recent paper overviews the importance of addressing the antibiotic resistance crisis by focussing on general practice and outlines strategies ad interventions that should be used to reduce antibiotic use in Australian general practice. It arose from discussions held at a national roundtable, attended by the Chief Medical Officers of Australia and the UK, that CREMARA hosted for researchers and key stakeholders (such as the Department of Health, Australian Commission on Safety and Quality in HealthCare, Therapeutic Guidelines, NPS MedicineWise, and the Royal Australian College of General Practitioners).

Moynihan, R., Barratt, A. L., Buchbinder, R., et al. (2018). Australia is responding to the complex challenge of overdiagnosis. MJA, 209(8), 332-334.

This article arose from a national summit on overdiagnosis in 2017 and outlines the emerging response in Australia to the problem of overdiagnosis. It highlights the development of an informal alliance of influential healthcare stakeholders, including leading professional and consumer/citizen organisations, many of which have endorsed a call to action to address this challenge.

Glasziou, P., Altman, D. G., Bossuyt, P., et al. (2014). Reducing waste from incomplete or unusable reports of biomedical research. The Lancet, 383(9913), 267-276.

Part of a Lancet series triggered by our 2009 Lancet paper (Chalmers & Glasziou) which documented the $85+ Billion annual loss in health research – from design flaws, non-publication, and inadequate reporting.

Has had global attention, including triggering the UK NIHR‟s “value in research” program, a yearly symposium.

This article has been cited 582 times.

Hoffmann, T.C., & Del Mar, C. (2017). Clinicians’ expectations of the benefits and harms of treatments, screening, and tests: a systematic review. JAMA Intern Med, 177(3), 407-419.

Hoffmann, T.C., Glasziou, P.P., Boutron, I., et al. (2014). Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. BMJ, 348, g1687.

A new reporting statement (official extension to the CONSORT and SPIRIT statements) for reporting interventions; developed with 15 international experts, including editors of BMJ and PLOS Medicine. It has had >100,000 views, >1700 citations, been translated into 3 languages, incorporated into Cochrane’s systematic review guideline, the subject of editorials and analysis pieces in >25 international journals, and endorsed as a required reporting guideline by many journals, including the BMJ.

Expectations about how much interventions can help or harm greatly influence care decisions. This landmark review found that clinicians rarely have accurate expectations and often overestimate intervention benefit and underestimate harm. It is the sister review to the 2015 systematic review of patients’ expectations (also published in JAMA Internal Medicine), which concluded that most patients overestimate intervention benefit and underestimate harm. The results of both reviews strongly support the need for shared decision making and evidence-informed discussion about an intervention’s possible benefits and harms. Both reviews are highly cited and had immense international and media attention (including an Altmetric score of 1960, which was the 103rd highest of all articles in the world published in 2017).

Doust, J., Vandvik, P.O., Qaseem, A., …, Glasziou, P. (2017).

Guidance for Modifying the Definition of Diseases: A Checklist.

JAMA Intern Med, 177(8); 1020-1025

Hoffmann, T.C., Légaré, F., Simmons, M. B., ..., Del Mar, C.B. (2014). Shared decision making: what do clinicians need to know and why should they bother? MJA, 201(1), 35-39.

This paper provides the first structured guidance for groups seeking to modify the definition of a disease. Guideline committees frequently widen disease definitions, with inappropriate widening of these definitions recognised as causing harm to patients and driving unsustainable growth in healthcare budgets. This checklist and guidance, developed by an international panel of multidisciplinary experts, is a crucial first step in facilitating more rigorous evaluation of changes to disease definitions prior to their implementation.

This paper was written after our institute initiated and hosted Australian’s inaugural shared decision making research symposium (in conjunction with NHMRC and the Australian Commission on Safety and Quality in Healthcare), which was attended by representatives from the co-hosting organisations, national and international researchers, consumer groups, private health insurers, NPS Medicine Wise, Choosing Wisely, and the New Zealand Health Quality and Safety Commission. It also led to the writing of Australia’s first statement on shared decision making by the NHMRC. This MJA paper was a call to arms. This MJA paper was published in the Centennial issue of MJA as the ‘future of healthcare’, was the 6th most downloaded MJA paper in its year of publication, and has >150 citations.

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SUPPORT OUR WORK The Institute for Evidence-Based Healthcare welcomes supporters from the corporate and philanthropic sectors. We are grateful to the many corporations, organisations and individuals who have already generously given time, funding and other support.

PHILANTHROPY • Become a corporate supporter • Empowering consumers to make informed decisions • Reducing overdiagnosis • Support team projects and programs

SPONSORSHIPS • Scholarships • Research assistants • Clinical research and implementation tools • Awards • Project resources

PROJECTS • Developing shared decision making aids for clinicians and patients • Deprescribing at end of life • Reducing low-value care • Rein in expanding disease definitions • Habit-based weight loss intervention • Mobile health apps • Risk prediction tools

PROGRAMS • • • • • • •

Minimising antibiotic resistance Reducing overdiagnosis and overtreatment Evidence-informed health decisions Reducing waste in research Evidence-based practice professorial unit HANDI (Handbook of Non-Drug Interventions) TIDieR (the Template for Intervention Description and Replication checklist)

MEET OUR TEAM Professor Paul Glasziou, Director Paul’s key interests include identifying and removing the barriers to using high quality research in everyday clinical practice. He is a leader within the Reward Alliance, investigating research waste and promoting better prioritisation, design, conduct, regulation, management and reporting of health research. Other interests include overdiagnosis and overtreatment, general practice, uptake of evidence for non-drug interventions, and automation of systematic review processes.

Professor David Henry David has a long-standing interest in evidence-based practice and has been a member of the Cochrane Collaboration for many years. He has been active in the field of drug safety and was executive co-lead of CNODES (cnodes.ca) a distributed network of Canadian data centres and scientists using administrative data to evaluate adverse drug effects.

Professor Chris Del Mar Chris is an academic GP. His research focuses on evidence-based practice and shared decision making, acute respiratory infections, any self-limiting disease including infections, skin cancer, and antibiotic resistance, in primary care. He has a national and international reputation in antibiotic overprescribing in acute respiratory infections, evidence-based medicine and systematic review, and randomised controlled trials, in both clinical medicine and health services research.

Associate Professor Rae Thomas Rae is a Psychologist with over 20 years’ clinical experience providing psychological interventions to children and families. Her program of research includes developing, implementing, and evaluating randomised controlled trials, embedding public voices in health guidelines and policy, exploring processes in health decision making particularly in relation to overdiagnosis, and translating research evidence to practice and policy.

Professor Tammy Hoffmann Tammy’s research spans many aspects of evidence-based practice, shared decision making, knowledge translation, and minimising waste in research. She has been involved in the development of a number of reporting guidelines. As part of her interest in improving the reporting, useability, and uptake of effective nonpharmacological interventions, she led the development of the TIDieR (Template for Intervention Description and Replication) checklist and guide.

Associate Professor Magnolia Cardona Magnolia is a health services researcher with a passion for ensuring high quality care of disadvantaged populations. Her work over the past few years has focused on the identification and reduction of overtreatment of older patients near the end of life in Australia, Europe and USA.

Professor Jenny Doust Jenny works as a general practitioner in Brisbane. Her research areas of interest are the use of diagnosis, screening and monitoring tests in general practice and the problem of overdiagnosis. She is a RACGP representative for the Choosing Wisely campaign.

Associate Professor Claudia Dobler Claudia’s research focuses on epidemiology and large database analysis, evidence-based medicine, knowledge synthesis and translation, and medical decisionmaking at a system and patient encounter level (using the tools of decision analysis and decision aids for shared decision-making).

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Associate Professor Mark Jones Mark’s areas of expertise and interest include clinical trials, systematic review and meta-analysis, reporting bias, and drug safety. He is Deputy Coordinating Editor for the Cochrane Acute Respiratory Infections Group and Consultant Statistician for the RIAT (Restoring Invisible and Abandoned Trials) Support Center.

Assistant Professor Sharon Sanders Sharon has expertise in evidence synthesis and systematic reviews of all study types. Her research interests are in overdiagnosis, including the methods of estimating overdiagnosis, the widening of disease definitions and in minimising research waste.

Assistant Professor Chrissy Erueti Chrissy has been the Institute Manager since 2010, after spending a number of years as an Educationalist and Academic Team Leader at the Western Institute of Technology in Taranaki (NZ). She is responsible for four functional areas: 1. Financial Management, 2. Human Resource Management, 3. Operational Management and 4. the Educational Program Management.

Assistant Professor Anna Scott Anna’s research primarily focuses on evidence generation and methodological development in two aspects of robust health policy decision-making: evidence syntheses (e.g. systematic reviews) needed to make sound, evidence-informed decisions; and the involvement of community members in those decisions. She also works on issues in waste in research (research governance).

Assistant Professor Ray Moynihan Ray recently won a prestigious NHMRC Early Career Fellowship and is a chief investigator within the NHMRC-funded Wiser Healthcare research collaboration for reducing overdiagnosis. A former award-winning journalist, he has written four books on the business of medicine, including ‘Selling Sickness’, translated into 12 languages. A one-time Harkness fellow at Harvard University, he currently presents The Recommended Dose podcast, produced by Cochrane Australia.

Dr Loai Albarqouni Loai is a Postdoctoral Research Fellow in Evidence Synthesis and Shared Decision Making. He is a medical doctor (MD) from Palestine and completed an MSc degree in clinical epidemiology at Ludwig Maximilian University of Munich.

His research interests include evidencebased practice, shared decision making, and primary health care.

Dr Mina Bakhit Mina’s key interests include evidence synthesis, shared decision making, and improving quality of reporting. His research focuses on patient-clinician communication and decision making about antibiotic use in primary care. He has a special interest in antibiotic resistance development and decay.

Dr Gina Cleo Gina is a Senior Postdoctoral Research Fellow and Accredited Practicing Dietitian. She is passionate about sustainable habitchange to achieve positive, long-term, health and well-being outcomes and is recognised as the only Australian researcher in this area. The novel outcomes of her research in habitbased interventions for long-term weight management have featured in over 130 media outlets, reaching over 7 million people.

Dr Zoe Michaleff Zoe has a strong interest in research methods and the evidence-based diagnosis, prognosis and sustainable management of musculoskeletal conditions across the life course.

Dr Jenalle Baker Jenalle’s background is in Neuropsychology and the early detection of Alzheimer’s disease. Her key interests include cognitive assessment, translation of clinical research, evidence-based practice, and evidence synthesis. Her research is focused on antibiotic use in residential aged care facilities.

Dr Alexandra Bannach-Brown Alexandra has expertise and interests in evidence synthesis, open science and the automation of systematic reviews. Her research involves developing and implementing automation tools to reduce waste in healthcare and biomedical research and improve research quality.

Dr Paulina Stehlik Paulina is a Senior Research Fellow and EBP Unit Coordinator, and president of the Gold Coast Skeptics.

She works with Gold Coast Health staff in EBP and Research development through teaching, strategic input, research consultation and mentorship. Her areas of interests include clinician research engagement and development, reducing research waste, using real-world data for research, regulation of health products, over prescribing, pharmacy practice and services.

Dr Matt Carter Matt is a software developer who specialises in the area of systematic reviews and other tooling within the automation team.

Liz Dooley Liz is the Managing Editor of the Cochrane Acute Respiratory Infections Group, with 20 years’ experience in the editorial processing of Cochrane systematic reviews. Liz is also a member of the Managing Editor Support team, providing induction and ongoing training, and support to Managing Editors in all aspects of their role within a Cochrane Review Group.

Liz is the Co-convenor of the Managing Editor’s Executive, and Managing Editor representative on the Cochrane Council.

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Justin Clark Justin is the Senior Research Information Specialist. His work focuses on locating and retrieving information in a way that minimises workloads for research teams. He has been working on developing tools and methods for the automation of systematic reviews. Justin is also completing his Masters of Science by Research at the Institute. His research, titled ‘Improved systematic searching for improving systematic reviews’, aims to improve the speed and efficiency of conducting systematic reviews by creating an enhanced way of conducting a systematic searching workflow which will combine the most effective methods of searching with a range of Systematic Review Automation tools.

Iris Gerke Iris works as a Research Administrative Officer for the Evidence-Based Practice Professorial Unit. She has many years’ experience as a Research Officer for various university hospitals in Germany. After moving to Australia, she followed her passion and became an Event Manager. Her previous role entailed working for a small IT company overseeing their administrative duties as well as coordinating events and conferences.

Honorary Associate Professor Elaine Beller Elaine is a biostatistician and clinical triallist with more than 25 years’ experience in research. One of her research areas is focused on reducing the waste in research effort by improving the quality of published research reports, particularly in systematic reviews and randomised trials. She led the PRISMA for Abstracts extension of the PRISMA Statement.

Amanda Murray Amanda has worked as a Research Assistant since 2015 focusing on GP recruitment and coordinating studies. Trials she has been involved in are the General Practice Antimicrobial Stewardship Programme (GAPS), Shared Decision Making and, more recently, the Community Pharmacist Referral to General Practice. She has over 20 years’ experience in industries including, health, law and business, with her current focus being GP engagement in research.

Additionally, Amanda has a Master of Art Therapy from the University of Western Sydney and is a professionally registered Art Psychotherapist. Her speciality in this field is child and adolescent mental health where she develops and facilitates art therapy programs to primary and secondary educational providers as well as working in private practice.

Melanie Vermeulen Melanie is the Research Administrative Officer for the Institute. She worked as an instructional developer for the University of Johannesburg before immigrating to Australia in 2008. She joined Bond University as a Laboratory Officer for the Faculty of Health Sciences & Medicine in 2009 and joined the Institute in 2013.

In her role she supports the research staff, the Manager of the Institute and the Director.

CURRENT HDR STUDENTS Dr Oyuka Byambasuren is completing her PhD and her research focuses on effectiveness of smartphone health apps and their usability in primary care. Her other interests include overdiagnosis, under-utilised non-drug interventions and science communication. Oyuka is also a medical doctor from Mongolia and completed her Master of Medical Research degree at Griffith University, Australia.

Dr Respati Ranakusuma is completing her PhD and her research focuses on identifying alternative treatment for acute otitis media in children. This was raised by her concerns on the over-use of antibiotics for common diseases, such as acute respiratory infections. Her other research interests are systematic review and health technology assessment.

Rhonda Morton’s professional background is in executive leadership of hospital and health services in Queensland and Western Australia. She now works with the Bond University Faculty of Health Sciences and Medicine, and is engaged in a PhD part time under the supervision of Professor Paul Glasziou and Associate Professor Rae Thomas. Her research interests include evidence-based non-drug treatments, reducing un-necessary side effects of healthcare, and evidence-informed decision making by patients for their own healthcare journey. Other interests include innovation and excellence in health service delivery, leadership, organisational design, and she provides private coaching for personal development.

Rebecca Sims is completing her PhD and her research focuses on public and professional perceptions of labelling of health conditions and involves exploration of why labelling of health conditions is influential. She has experience in researching osteoporosis, antibiotic resistance, alternatives to antibiotics, overdiagnosis, and stigma of psychological conditions. She is a Clinical Psychology Registrar and completed her Master of Psychology (Clinical) at Bond University, Australia.

Ann Bryant is completing her Master of Science by Research under the supervision of Associate Professor Rae Thomas and Assistant Professor Anna Scott. Her research aims to develop, pilot and evaluate a model for involving patients and the public in the development of Australian clinical guidelines; and, from these findings embed acceptable and feasible patient and public involvement strategies in the development of clinical practice guidelines. She completed her Master of Applied Science (Agriculture) at Charles Sturt University, Australia and Graduate Diploma of Psychology at Central Queensland University, Australia.

Dr Thanya Pathirana is completing her PhD on overdiagnosis of prostate cancer in Australia. She is a medical doctor from Sri Lanka and she completed her Master’s in Public Health at Griffith University, Australia in 2014. Her other research interests include overtreatment, medical education and health promotion.

OTHER STAFF Dr Eman Abukmail Research Assistant Dr Ruwani Peiris Research Assistant Ann Jones Joint Managing Editor, Cochrane ARI Group Connor Forbes Software Support Officer Please refer to our website iebh.bond.edu.au/ about-us/our-team for contact details.

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Contact us Institute for Evidence-Based Healthcare Bond University Building 5, Level 4 Gold Coast Queensland 4229 AUSTRALIA Email: iebh@bond.edu.au Phone: +61 7 5595 4482 iebh.bond.edu.au @Institute4EBH /Institute4EBH /Institute4EBH