Health professionals are increasingly providing treatment based on evidence of clinical effectiveness. The evidence consists of rigorous and up-to-date scientific research that has shown the treatment to be largely beneficial. Providing evidence-based treatment involves the constant evaluation of the most effective treatments for a health condition. It often entails replacing established treatments with new or different ones that have been shown to be more effective or safer. Providing evidence-based treatment can also involve the acknowledgement of uncertainty about the most effective treatment, as the quality of clinical evidence can vary or the appropriate research may not have been done.
Good quality written consumer health information about treatment choices will be accurate and will be based on the best and most up-to-date scientific evidence. It will help you consider all aspects of a treatment choice, including the outcomes of a treatment choice and any areas of uncertainty. It is possible that issues other than clinical effectiveness will also be important when deciding about treatment, and good quality information will help you to choose the option that is best for you.
Even where there is a clear course of action and your treatment choices are limited, good quality written information will help you to understand your treatment and to know what to expect from treatment.
There is currently a lot of written consumer health information on treatment choices available from a variety of sources, including the internet. Not all of this information is good quality and only a small proportion is based on good evidence. Many of the publications available provide inaccurate or confusing advice, and it may be hard to know which information to use and which to discard. DISCERN is an instrument, or tool, which has been designed to help users of consumer health information judge the quality of written information about treatment choices.
DISCERN is suitable for anyone who uses or produces information about treatment choices. Its uses are diverse and include:
DISCERN has undergone an extensive process of development and evaluation. A brief summary of the process follows.
We asked an expert panel to analyse a random sample of consumer health information on treatment choices for three medical conditions with varying degrees of evidence: myocardial infarction, endometriosis and chronic fatigue syndrome. A draft instrument based on the panel’s analysis was tested by the expert panel on a random sample of new material for the same three conditions.We analysed the performance of the draft instrument using a measure of inter-rater agreement (weighted kappa) and panel debate. The instrument was re-drafted to take account of the results of the analyses.The final pilot of the DISCERN instrument was conducted by a national sample of 13 self-help group members and 15 information providers on a random sample of leaflets from 19 major national self-help organisations.We conducted tests of inter-rater agreement, and participants were asked to complete a questionnaire assessing their views on the validity and applicability of the instrument.
The rigorous process used to develop DISCERN has enabled us to identify a general set of guidelines for the content of written information on treatment choices which can be consistently understood and applied by a wide range of users. Consequently, DISCERN is the first standardised index of quality of consumer health information.
Further details of how DISCERN was developed were published in the Journal of Epidemiology & Community Health, February 1999.
Here are some other important details about DISCERN and its use.
DISCERN cannot be used to assess the scientific quality or accuracy of the
evidence on which a publication is based, as this would require checking against
other sources. DISCERN can be used to judge the reliability of a publication
as a source of information about treatment choices. DISCERN can be used to
assess whether the sources of evidence are explicit. Question 4 is designed
to help you assess whether it is clear where the information about treatment
choices has come from. Sources can include research articles, clinical experts
and representatives from organisations to
assess the most common causes of inaccurate or unreliable information such as
whether the publication or the information on which it is based:
DISCERN can be used to judge the quality of a publication without the need
for specialist knowledge and without reference to other publications or advisers.
You can use DISCERN on your own to judge the quality of a single publication.
DISCERN may also raise important issues which will lead you to seek further
information or advice, and may be useful for selecting and comparing a range
of information about treatment choices.
DISCERN can be used to judge the quality of publications about one particular treatment choice. It is common for a publication to describe one particular treatment for a health problem. Such publications can provide good quality information as long as it is clear that only one treatment choice is being discussed (Question 1) and that other treatment choices may be available (Question 6, Question 14). Apply DISCERN to these publications in the same way as you would to publications about numerous treatment choices: Questions 9-15 are relevant to a single treatment.
DISCERN is designed to help you rate the quality of a publication in terms of its content.We have not included specific questions about the presentation of information (e.g. layout, graphics, readability), as there is already a lot of literature on the importance and use of these features. Furthermore, a publication that is well presented and readable is not necessarily informative and accurate. DISCERN has been developed to fill a gap by examining what information a publication is providing, rather than how it is providing it.
Presentation is an important component in the overall production of good quality information. For more information about presentation and other issues relevant to the production of consumer health information, please contact the Centre for Health Information Quality in Winchester, who will be happy to advise you.