How Is Evidence-Based Practice Formulated?

Evidence-based practice (EBP) combines evidentiary research with clinical experience. Primarily used in the health field, it is sometimes referred to as evidence-based medicine (EBM).



Evidence-based practice must be clinically relevant but also pulls from the experiences of patients in changing the way medicine is practiced. The role of patient values including their expectations, concerns and preferences is a key component of EBP/EBM. The goal of EMP is to combine research, health-care professional and patients into a research team.

Definition

• The most common definition of evidence-based practice is taken from Sackett, et al, who describe it as "the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence-based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research."

  A key part of this definition is that evidence-based practice draws upon both the clinical knowledge and the external, academic knowledge. Both are needed for EBP to be done effectively.

Getting Started

• The two most important qualities of engaging in evidence-based practice according to Stillwell, et al, is having "both a spirit of inquiry and a culture that supports it." Some would even call this "Step Zero" because nothing will happen without the health-care professional being interested in looking deeper at medical issues and finding unique solutions or new treatments.

Formulating A Question

• All evidence-based practice starts with a clear research question.

  In order to start research you must determine a key question and think about how to examine it. Good questions come from your work experience as a health-care professional, trends in the industry, published research on similar topics and theory about this issue. A good question is clearly developed, relevant and focused. It is very clear and direct, has been well thought out and includes all necessary components.

Background vs. Foreground Questions

• There are two types of questions that can be asked. Background questions are who, what, where, when, why and how. When a question is created using this method, it tends to be very broad and wide-ranging.

  Foreground questions -- which are common with experienced clinicians -- are very specific. A foreground question is always focused and clinically relevant. As a result, the research is more likely to give concrete results compared to a weak, backgrounded question.

  In evidence-based practice these tend to follow a pre-determined pattern for developing a questions such as PICO or COPES. Both of these will be explained in more detail.

COPES

• The Client Oriented Practical Evidence Search method of asking questions dictates that questions have three common features. They should stem from daily practice, be posed by a health-care practitioner and should matter to the client's well-being. COPES questions are "Client Oriented," which could be an individual, group of clients or whole community. The question is "practical" in that it is relevant to everyday problems that occur, apply to the overall agency or institution's mission or the answer could provide an effective result. Finally, COPES questions are formulated to be clear enough that they can be used in an "Evidence Search," usually through electronic means.

PICO

• The most common way to formulate a question in evidence-based practice is using the PICO or PICOT method. This method incorporates key components that must be included when formulating the question. You need to identify the "patient population," the "intervention or area/issue of Interest," the "comparison" intervention or group and the "outcome." Sometimes the "time" that will be needed for the intervention is also included. As with COPES, structuring a question in this way should allow for easy searching of electronic databases. This is crucial because evidence-based practice must incorporate existing knowledge and research outside the health-care professional's own experience.