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?

License

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Evidence-Based Practice by Various Authors - See Each Chapter Attribution is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License, except where otherwise noted.