Evidence-based practice (EBP)
Evidence-based practice (EBP) is a systematic approach to clinical patient care that integrates the best available research evidence, clinical expertise, and patient preferences. It emphasizes the need for clinicians to assess each patient's unique circumstances, including their values and experiences, to inform treatment decisions. EBP is widely applicable across various fields such as medicine, nursing, psychology, and allied health. The process involves several key steps: assessing the patient, formulating clinical questions, acquiring relevant literature, appraising the quality of the evidence, applying the findings in practice, and evaluating outcomes.
This approach not only improves the quality of patient care but also enhances the overall patient experience by involving them in the decision-making process regarding their treatment. The PICO framework (Population, Intervention, Comparison, Outcome) is a valuable tool in guiding literature searches to ensure the evidence gathered is pertinent to the specific clinical scenario. While EBP aims to provide effective, individualized care, it also faces challenges, particularly in balancing generalized research findings with the unique needs of individual patients. Proponents argue that EBP fosters a holistic approach to health care that respects diverse perspectives and enhances patient outcomes.
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Evidence-based practice (EBP)
Evidence-based practice (EBP) is the amalgamation of research evidence, experience and expertise, and patient preferences in the process of clinical patient care. Clinicians bring collected experience, while patients describe personal values and past encounters. These two aspects are combined with clinically relevant research that has been proven with comprehensive methodology to develop the most optimal outcome in the patient’s care process and overall quality of life. EBP can be incorporated into various fields such as medicine, nursing, psychology, and allied health. Patients typically prompt EBP by asking questions regarding things like the purpose of diagnostics, the effect of certain therapies, disease prognosis, and the historical relevance of diseases.
EBP requires the medical professional to develop their skills in searching literature and applying guidelines for evidence. The steps of the practice are: assessing the patient, asking questions to build the case, acquiring evidence from clinical literature, appraising the evidence, applying and discussing evidence with the patient, and evaluating the results and performance. Completion of the EBP steps allows the physician to identify, strategize, and discuss with the patient the most appropriate holistic recovery process.
Background
EBP is the conscientious, categorical, and astute approach towards a patient’s holistic health using the current and most appropriate clinical literature available, tailored to fit the patient’s specific health requirements and conditions. The first step in EBP is to ask clinical questions to familiarize the attending professional with the patient—not only in terms of anatomy and symptoms but also regarding their background, values, and wishes—thus defining the types of questions and clinical studies to focus on during clinical literature review. It is important to acquire a well-built and comprehensive literature search based on the PICO concept (Population/Patient/Problem, Intervention(s), Comparison, Outcome) and to identify all potentially relevant scientific articles, which are then evaluated for the compatibility and relevance to the patient’s case. It is essential for physicians, counselors, and other clinical practitioners to continuously enhance the skills required for exhaustive literature review, as these tasks can determine the efficiency or, conversely, the impairment of the patient’s recovery.
Before approaching the libraries of clinical literature, the attending professional must correlate the most common types of questions (diagnosis, therapy, prognosis, or harm/etiology) with the most relevant type of study in order to produce the best study design. For diagnostic questions, potential studies must be compared to gold standards or cross-sectional studies. Studies on controlled clinical trials must be sought to answer questions regarding therapy, such as the cost and potential harms, before delving into cohort studies. To answer questions regarding prognosis and the causes of a disease, focus should be assigned to cohort studies, followed by case controls and case series.
Study designs are categorized from the most general to the most isolated and concentrated ideas: animal research, case series/case reports, case control studies, cohort studies, randomized control trial, systematic review, and meta-analysis. Case series/case reports are collected reports on the treatment of a single patient and have minimal statistical validity, given its lack of comparison between control groups and its general understanding of the question. Meta-analysis, being the most specified of the study designs, have thoroughly examined numerous validated studies and have combined the most statistically viable results to elaborate a cause-and-effect relationship between varying treatments and the resulting effects on patient conditions. These studies can be acquired by using the PICO concept during clinical literature review. Large databases, such as PubMed and Medline, can provide primary literature, while secondary sources offer assessments of original studies.
Overview
EBP incorporates externally proven scientific evidence, client/patient/caregiver perspectives, and clinical expertise or expert opinions in an attempt to provide the most effective and holistic approach in patient recovery and treatment. It intends to improve the social or clinical problems of various types of patients, especially in medicine and psychology (though it has also been applied to such fields as education and social work). Following examination of the patient, postulating all the appropriate questions, and acquiring all the applicable clinical studies, the attending professional must appraise the validity of the study for the individual patient.
Prognosis studies must clearly define the spectrum of conditions present and show significant similarities with regards to the prognostic factors of the patient (such as age, gender, race, disease, and stage of disease), thus making it easier to discern the most relevant study for the particular case. Valid prognosis studies must provide sufficient records for follow-up examinations and minimize objectivity and bias on the presented outcome criteria. Likewise, those following EBP must consider both clinical and statistical significance of the results given that clinical significance requires a sizable change in the patient’s condition, whereas statistical significance is powered by a large number of observations and oftentimes produces only a trivial amount of noteworthy outcomes. Clinical significance prioritizes judgement rather than statistics, such that relevant studies can be determined statistically significant but clinically insignificant. It is essential to correctly match the individual patient’s condition to population studies when applying the literature results to the patient. This allows categorization between the potential primary and secondary clinical outcomes and notes the potential harms and costs the patient may encounter.
In addition to medical organizations, government and academic organizations increasingly use EBP in clinical decisions and the creation of policy. Although this practice has positive intentions, challenges may arise when EBP-based policies and guidelines are spread and implemented. EBP relies strongly on the judgement of the attending physician, counselor, or other professional. Although previously validated with sound evidence, research evidence does not provide clear guidance on the treatment of every individual patient under every circumstance. Critics have claimed that the generalized approach does not always result in the most effective means of treatment for the individual patient. However, proponents of EBP counter that the combination of broad evidence with clinical expertise—and the patient’s ability to define their preferences—generates a holistic approach towards treatment and recovery that balances general best practices with individualized care.
Bibliography
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Prendergast, Michael L. "Issues in Defining and Applying Evidence-Based Practices Criteria for Treatment of Criminal-Justice Involved Clients." Journal of Psychoactive Drugs Suppl. 7 (2011): 10–18.
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