Applying the Evidence
Once you have determined that the study and its results are valid, you need to decide if it applies to your specific patient/population and situation.
Factors to consider include:
- Similarities between your patient/problem/population and those in the study;
- The needs and wishes of your patient or population;
- The clinical significance of the results;
- And the availability of said interventions in your practice or setting.
Remember that EBP balances three elements: 1) the latest, best evidence; 2) the patient or community’s values, needs, and preferences; and 3) your expertise.
You may want to consider questions such as the following:
Diagnosis
Example application questions:
- Is the test affordable, accurate and available in my practice or hospital?
- How likely is it that my patient has the disease if the results are positive (i.e. positive predictive value or post-test probability of a positive test)?
- How likely is it that my patient does not have the disease if the results are negative (i.e. negative predictive value or post-test probability of a negative test)?
- Will the test results change my management decisions (i.e. treatment plan)?
- What is the cost (financial and otherwise) and relative value of alternate tests?
Example of patient-oriented application questions:
- Will my patient be better off because of this test?
- Will the diagnosis impact patient-important outcomes, e.g. quality of life, death, disability, cost, etc?
Therapy/Intervention
Example application questions:
- Is my patient similar enough to those in the study that the results would be valid?
- According to the study results, how much would my patient benefit from the treatment?
- Were the results clinically significant (i.e. change is tangible and valuable to patients) or just statistically significant?
Example of patient-oriented application questions:
- What is the quality of life with this treatment as compared to others?
- Does the intervention reflect my patient’s or community’s needs, values, and preferences?
- Will my patient be able to adhere to the treatment requirements?
Harm
Example application questions:
- Can the study results be applied to my patient or population?
- How large is the risk identified in the study?
- How does the risk of the intervention compare with its potential benefits?
- Are there alternative interventions with a lower risk of harm?
- How do the potential harms align with the needs, values, and preferences of your specific patient or community?
Prognosis
Example application questions:
- Is my patient similar to the patients in the study group?
- How strong is the evidence behind the prognostic factor?
- Are the results useful for counseling your patient?
- What was the prognosis on related outcomes (e.g. disability and quality of life)?
Program/Quality Improvement
Example application questions:
- Is the setting or population of the article similar to your practice or community?
- Will this change improve safety concerns (e.g. protect patients from medical errors)?
- Is this change or program effective and efficient?
- Does this program align with the community’s needs, values, and preferences?
- Are there resources (money, staff, training, etc.) to support new programming?
Economic Evaluation
Example application questions:
- Are the treatment benefits worth the corresponding risks and costs?
- Will the costs be similar in your setting?
- Will implementing this new program or intervention result in decreased resources to existing services? What will be the consequences of that decrease?
