Skip to Main Content

Evidence Based Practice: Evidence Based Practice

Evidence Based Practice Stages and Pyramid

 

WHAT IS EVIDENCE BASED PRACTICE?

The most common definition of EBP is taken from Dr. David Sackett, a pioneer in evidence-based practice. EBP is "the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient. It means integrating individual clinical expertise with the best available external clinical evidence from systematicresearch." (Sackett D, 1996)

EBP is the integration of clinical expertise, patient values, and the best research evidence into the decision making process for patient care. Clinical expertise refers to the clinician's cumulated experience, education and clinical skills. The patient brings to the encounter his or her own personal and unique concerns, expectations, and values. The best evidence is usually found in clinically relevant research that has been conducted using sound methodology. (Sackett D, 2002)

 

 

British Medical Journal- Recent Issues

  • Successes, shortcomings and learning opportunities for evidence-based medicine from the COVID-19 pandemicThis link opens in a new windowJan 22, 2025

    The COVID-19 pandemic represents the largest public health crisis of the past century. Faced with a global threat, public health officials, professional societies, clinicians and patients have appropriately sought strategies to prevent SARS-CoV-2 transmission, reduce progression to severe and critical illness, and mitigate short-term and long-term sequelae. Efforts have extended to drug therapies, non-pharmacological interventions (vaccination, ventilation strategies in critically ill) and system-level policies (masking, vaccination, quarantining, isolation, physical distancing, and remote work and study).

    First reports of cases of pneumonia originating from Wuhan, China, emerged on 31 December 2019. A PubMed search conducted from 1 January 2020 to date using keywords related to coronavirus, COVID-19, SARS-CoV-2 and novel coronavirus-2 yields over 439 000 hits, representing a daily publication rate of over 260 articles. A living systematic review of registered clinical trials for COVID-19 identified 15 624 registrations up to 2023; now, over five years into the pandemic, researchers continue to...

  • Teaching evidence-based medicine by using a systematic review framework: implementation in a Swedish university settingThis link opens in a new windowJan 22, 2025
    Introduction

    Evidence-based practice improves healthcare and patient outcomes, by providing a framework for integrating research into clinical practice. Evidence-based practice is considered a core competency in medical education.1–6 Here, the term evidence-based medicine (EBM) describes evidence-based practice in medicine and healthcare. The core competencies in EBM are often described as the ability to:

  • Formulate a research question

  • Find best available research

  • Critically appraise research findings

  • Evaluate strength/certainty of evidence

  • Although these competencies are part of curricula for medical and health education programmes in Sweden, there is no consensus on which methods best support learning of EBM.7 8 Teaching varies between contexts regarding (a) emphasis on EBM in a curriculum, (b) teaching methods, (c) online versus in-classroom or clinical setting, (d) frequency of learning and (e) assessment of...

  • Use of digital patient decision-support tools for atrial fibrillation treatments: a systematic review and meta-analysisThis link opens in a new windowJan 22, 2025
    Objectives

    To assess the effects of digital patient decision-support tools for atrial fibrillation (AF) treatment decisions in adults with AF.

    Study design

    Systematic review and meta-analysis.

    Eligibility criteria

    Eligible randomised controlled trials (RCTs) evaluated digital patient decision-support tools for AF treatment decisions in adults with AF.

    Information sources

    We searched MEDLINE, EMBASE and Scopus from 2005 to 2023.

    Risk-of-bias (RoB) assessment: We assessed RoB using the Cochrane Risk of Bias Tool 2 for RCTs and cluster RCT and the ROBINS-I tool for quasi-experimental studies.

    Synthesis of results

    We used random effects meta-analysis to synthesise decisional conflict and patient knowledge outcomes reported in RCTs. We performed narrative synthesis for all outcomes. The main outcomes of interest were decisional conflict and patient knowledge.

    Results

    13 articles, reporting on 11 studies (4 RCTs, 1 cluster RCT and 6 quasi-experimental) met the inclusion criteria. There were 2714 participants across all studies (2372 in RCTs), of which 26% were women and the mean age was 71 years. Socioeconomically disadvantaged groups were poorly represented in the included studies. Seven studies (n=2508) focused on non-valvular AF and the mean CHAD2DS2-VASc across studies was 3.2 and for HAS-BLED 1.9. All tools focused on decisions regarding thromboembolic stroke prevention and most enabled calculation of individualised stroke risk. Tools were heterogeneous in features and functions; four tools were patient decision aids. The readability of content was reported in one study. Meta-analyses showed a reduction in decisional conflict (4 RCTs (n=2167); standardised mean difference –0.19; 95% CI –0.30 to –0.08; p=0.001; I2=26.5%; moderate certainty evidence) corresponding to a decrease in 12.4 units on a scale of 0 to 100 (95% CI –19.5 to –5.2) and improvement in patient knowledge (2 RCTs (n=1057); risk difference 0.72, 95% CI 0.68, 0.76, p<0.001; I2=0%; low certainty evidence) favouring digital patient decision-support tools compared with usual care. Four of the 11 tools were publicly available and 3 had been implemented in healthcare delivery.

    Conclusions

    In the context of stroke prevention in AF, digital patient decision-support tools likely reduce decisional conflict and may result in little to no change in patient knowledge, compared with usual care. Future studies should leverage digital capabilities for increased personalisation and interactivity of the tools, with better consideration of health literacy and equity aspects. Additional robust trials and implementation studies are warranted.

    PROSPERO registration number

    CRD42020218025

Evidence Based Practice Resources

Books about EBP

FAQs