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Evidence-Based Practice: Step 4

A tutorial on evidence-based practice.

Steps in the Process

  • Step 1: FORMULATE an answerable question

    The first step in this tutorial helps you to refine your question by defining your clinical problem using a process called PICO. Through this process you will create an “answerable question”. This process will facilitate your search by helping you to identify keywords specific to the patient population, intervention, comparison group and outcomes that are appropriate to your patient care inquiry.

     

  • Step 2: SEARCH FOR the best evidence using the keywords from your PICO question

    The second step in this tutorial helps you to search for an evidence-based answer to your question using the keywords from your PICO question. Through the process you will become aware of four different types of information resources you can use in your search.

     

  • Step 3: ASSESS the validity and usefulness of the search results

    The third step in this tutorial helps you to evaluate your search results. Through this process you will identify the studies which are valid and useful to your question, and then identify and compare the study conclusions. If there are conflicting results, you must look at the evidence to find explanations for the differences and resolve them.

     

  • Step 4: APPLY the evidence

    The fourth step in this tutorial helps you to apply the evidence to your clinical scenario. Through this process you will determine if the evidence can be extrapolated to your patient and then communicate with your patient to make an informed decision.

    • Step 4: APPLY the evidence

    Up to this point you have gathered and assessed the evidence related to your clinical question. You are now ready to apply your findings and then evaluate if the intervention (the I in PICO) should be accepted, rejected or modified for clinical practice.

    Once you have determined that a study is internally valid and you understand the findings, you must decide if the results of the study can be applied to your patient. If the results are not totally applicable to your patient, you must determine how your patient differs from the subjects of the study and to what extent you can use the findings as a guideline for clinical decisions. You must also determine how great the benefit of therapy would be for your patient, whether the treatment would meet the patient's expectations, and the risk for adverse effects.


    Questions to Ask Regarding Applying the Evidence:

    I. Are the outcomes of the evidence relevant to the patient/problem?

  • Do the benefits outweigh the harm that could affect the patient?
  • Does the patient have specific values or a life situation that will affect the outcome?

    II. Do the results apply to my patient?
  • Is the patient similar to those studied?
  • If not, what are the important differences?

    III. Is my patient likely to benefit from this change in practice?
  • What is the patient's baseline risk for adverse outcome?
  • Are there any co-morbidities or contraindications?

    IV. What do the patient and the patient's family want?
  • Are there any social or cultural factors to consider?
  • Are there family needs and values to consider?
  • Does the patient have values or preferences to consider?

    These questions are derived from Applying the Evidence to the Care of Your Patient from the Department of Family Medicine at the University of Washington.


    CONGRATULATIONS YOU HAVE FINISHED THE TUTORIAL!