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Advancing quality in health policy decision-making in the face of uncertainty: an integrated review to characterize and address uncertainty.

Date and Location




Monday 23 September 2013 - 10:30 - 12:00


Presenting author and contact person

Presenting author

Melissa Brouwers

Contact person

Melissa Brouwers
Abstract text
Background: Evidence-based decision-making has become a cornerstone of effective health care in both clinical and policy contexts. Specific to the health policy setting, decision-makers must make decisions within the context of uncertainty, a phenomenon that has been poorly understood. Specifically, while research in this area has focused on key themes, a better articulation of the specific types of uncertainty, their impacts, and strategies available to navigate or mitigate them are warranted. Objectives: Our aim was to identify and characterize the unique uncertainties experienced by health policy decision-makers and to identify strategies for how to deal with them. A systematic review of the literature was undertaken to identify: 1) types and sources of uncertainty that decision-makers experience; 2) the impacts of these sources of uncertainty on decision-making; and 3) strategies to measure, navigate, and mitigate uncertainty. Methods: Scopus and Ovid Medline databases (1995-2011) were searched for English language articles relating to health policy and uncertainty, complemented by a targeted book review and search of the grey literature. Results: A total of 292 articles met inclusion. Three domains comprising 12 factors were identified: scientific (clinical, methods, evidence, statistics, models, generalizability), structural (adoption, practical, affordability), and contextual (acceptance, political, values). Impacts of uncertainty included delayed action, avoidance, suboptimal decisions and non-recommendation. Over 30 formal strategies to deal with uncertainty were identified, ranging from statistical methodologies, to formal methods used in policy contexts, to broader principles (e.g., Precautionary Principle). Conclusions: We successfully characterized uncertainty in the health policy context and created a working framework. These findings will be taken forward to develop a tool to assist health policy decision-makers to navigate uncertainty.