Clinical Decision Making and Evidence-Based Practice

The development of the information society poses many challenges to medical science and practice. There is a tendency to increase the amount of medical information and the development of science-intensive medical technologies. Patients’ demands to obtain qualified medical care from several sources are growing. At the same time, the limited financial resources of health care, even in industrialized countries, are becoming increasingly evident, which calls for the support of solutions for the development and implementation of new efficient medical technologies. All of this creates the need for society to practice evidence-based practice (EBP) to smooth out acute angles between patients and healthcare providers.

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The defining tenet of the EBP is that every clinical decision made by a physician must be based on scientific evidence. In seeking a solution to a clinical problem, the clinician may use different sources of information and receive differently, sometimes mutually exclusive, facts and recommendations (Cullen et al., 2005). Theoretical insights into the mechanisms of disease based on information from biochemistry, anatomy, and physiology do not allow for a straightforward prognosis of the course of illness and the choice of therapy, as too many factors influence the outcome of the disease. This leads to the conclusion that EBP includes another no less critical postulate: the value of the obtained fact, the higher, the stricter the methodology of its study (Portney, 2020). In addition, the clinician’s authority, status, and personal experience should not influence treatment choices; such choices should be based on qualitative evidence of the advantages of a particular method.

Evaluating the level of evidence of a method is the primary working tool for applying evidence-based medicine in practice. In the field of EBP, there is an excellent variety of models aimed at assessing the validity of the results proposed by the authors (Cullen et al., 2005). One such model is the Stetler method, which is based on the five-step testing of results (Indra, 2018). The EBP analysis methodology is based on a data collection and analysis model that allows for an integrated approach to obtaining new information and assessing existing evidence on the intent, implementation, and social outcomes of the practice.

The effectiveness of a therapeutic or preventive intervention is often studied in numerous clinical studies, the results of which may not be uniform. The results of these studies are usually summarized in detailed reviews to provide a quick overview of the issue of interest (Indra, 2018). However, the content of such reports may be influenced by the author’s opinion, as well as by the incomplete selection of the studies being analyzed, which may lead to misunderstandings about the drug or treatment method. Clinical guidance based on levels of evidence, including RCTs, systematic reviews, can help to avoid these weaknesses (Cullen et al., 2005). The use of described methods in research allows the treating physician to assess the degree of evidence from scientific publications.

The potential for applying evidence-based medicine principles in health care practice is significant. First of all, their application allows using objective criteria for all aspects of pharmacotherapy. EBP principles allow optimizing the influence of such subjective factors as intuition and qualification of a doctor, opinions of authoritative experts, recommendations of popular manuals, and reference books (Portney, 2020) on decision making, taking into account the latest and reliable information. In other words, the EBP implies combining the individual clinical experience of a physician with the best available independent clinical evidence from systematized research. In addition, the main objective of the guidelines is to translate clinical trial results into clinical guidelines. It is essential to understand that clinical guidelines are not formally valid, but are a tool to help clinicians make optimal therapeutic choices. However, they can be used in deciding on the correctness of treatment, including in court.

References

Cullen, L., Dawson, C., & Williams, K. (2005). Evidence-based practice: Strategies for nursing leaders. Leadership and Nursing Care Management, 3(1), 461-78.

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Indra, V. (2018). A review on models of evidence-based practice. Asian Journal of Nursing Education and Research, 8(4), 549-552.

Portney, L. G. (2020). Foundations of clinical research: Applications to evidence-based practice.

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