Evidence-Based Practice (EBP) - INTRODUCTION AND STEP 1

EVIDENCE-BASED PRACTICE
(EBP)
https://guides.library.unisa.edu.au/ebp/Overview
EBP DEFINITION CONT…
• In the clinical setting, health professionals make decisions about patient care every day. Evidence-based practice (EBP)
is an approach which helps guide this decision-making.
• “Evidence-Based Practice requires that decisions about health care are based on the best available, current, valid and
relevant evidence. These decisions should be made by those receiving care, informed by the tacit and explicit
knowledge of those providing care, within the context of available resources
• In short EBP, decisions about patient care are guided by three kinds of information:
• best research evidence

• clinical expertise
• patient values and circumstances
• Clinical expertise
• Clinical expertise is a combination of clinical skills, medical knowledge, and
professional experience that is accumulated by practitioners over the course of their
career.
• Clinical experience is important because research evidence on its own is not enough
to inform practice - it needs to be contextualised to local environments and specific
patients.
• As a practitioner you will need to use your expertise to assess the research and
decide on the best course of action.
• Best research evidence

• Best research evidence refers to up-to-date and authoritative scientific research into
various aspects of patient care, diagnosis, treatment or prevention of disease.
• Patient values and circumstances
• Patient values and circumstances relate to the unique preferences, concerns,
expectations, beliefs, hopes, strengths, limitations, and stresses that each patient brings
to a clinical encounter.
PURPOSE & IMPORTANCE
• Practitioners use EBP to ensure that decisions about patient care are informed
by the best possible information.
• The purpose of EBP is to:
• improve quality, effectiveness and appropriateness of clinical practice
• reduce variations in practice patterns
• substantiate the care provided to patients
• share decision-making with the patients
• provide a framework for lifelong, self-directed learning crucial for continued provision
of quality care
EBP STEPS- 5 As
• There are five key steps in the evidence-based practice process, starting with
formulating a question and ending with the evaluation of practice. These steps
may be linear, or they may lead you to another clinical question to investigate.
STEP 1: ASK
• Clinical problems often do not arise as
perfectly formulated questions - they are
complex and have many different aspects
to consider. However, without a clear
question it can be difficult to find the
information you need to inform your
practice.
• The first step of the EBP process is to
convert your problem into a structured
and answerable clinical question.
BACKGROUND/FOREGROUND
QUESTIONS
• There are two main types of clinical questions: background questions and
foreground questions. Knowing whether you are asking a foreground or
background question will help you decide where to search for information.
TYPES OF FOREGROUND QUESTIONS
There are five different types of foreground questions, each focusing on a different action in response to the clinical problem: therapy or intervention; prognosis;
harm/etiology; diagnosis; and prevention.
• Therapy / Intervention
• If you are asking What should I do to help my patient? you are asking a therapy or intervention question.
Therapy questions explore potential interventions that could be used to treat or manage a patient's condition. They are used to evaluate the effectiveness of different medications, physical
therapy, surgical procedures, lifestyle changes, etc.
• Prognosis
• f you are asking What will happen to my patient in the future? you are asking a prognosis question.
Prognosis questions explore the likelihood of particular outcomes for patients with particular disorders. They are used to predict the patient's expected development and anticipate any future
complications.
• Harm / Etiology
• If you are asking Why has this happened to my patient? you are asking a harm or etiology question.
Harm/etiology questions explore the causes and likelihood of a health care problem. They are used to find the origin of a patient's condition so that decisions about their care can be made.
• Diagnosis
• If you are asking How should I determine if my patient has a particular condition? you are asking a diagnosis question.
Diagnosis questions compare the accuracy and safety of diagnostic tests against the standard method. They are used to determine which test will be the most accurate in confirming or
excluding a particular condition.
• Prevention
• If you are asking How can I prevent a specific outcome for my patient? you are asking a prevention question.
• Prevention questions explore ways to reduce the likeihood of particular condition or disease. They are used to reduce the chance of disease by identifying and modifying risk factors.
TYPES OF FOREGROUND
QUESTIONS
• Each type of question is best answered by different types of research studies.

• Knowing which type of question you are asking will help you decide which
resources you need to locate.
• This will be covered more in Step 2: Acquire (Search).
BUILDING FOREGROUND QUESTION
The PICO framework can help you convert your clinical

problem into an answerable question.
The PICO framework can be used to break the problem

down into four components:
• the population
• the intervention or treatment,
• the comparison treatment (if required), and
• the outcome that need to be investigate.
These components can be used first to build the clinical
question and later as keywords when searching for
information.
PICO
P
• The population, patient or problem element identifies the health issue you are investigating and who it is affecting
• Ask yourself:
What are the key characteristics of the patient?
How would you describe a similar group of patients?
Is age, sex, ethnicity, general health, or any other factor relevant to their diagnosis or treatment?
I
• The intervention element considers what you are going to do about the health issue you are investigating.
• Ask yourself:
Which main intervention, prognostic factor, or exposure are you considering?
What do you want to do for the patient? (e.g. treat, diagnose, observe)
C
• The comparison element looks at alternative treatments to compare against your intervention.
• Ask yourself:
• What is the standard treatment to compare with?
• What is the alternative care option to compare with?
• Note: Not all clinical questions use a comparison.
O
• The outcome element addresses what you are trying to achieve through your intervention.
• Ask yourself:
• What are you trying to do for the patient?
• What can you hope to accomplish, measure, or improve?
• Are you trying to relieve or eliminate specific symptoms? Reduce adverse affects?
PICO EXAMPLE
PICO element Relevant clinical

CASE SCENARIO
information
P: Population/pati a 34 year old male with no
ent/problem chronic medical conditions
experiencing back pain
I: Intervention using muscle relaxants
C: Comparison using opioids
O: Outcome relieving back pain
• Once the PICO elements are identified, then they need to be

brought together to create a well formulated question.
• No matter in which the PICO elements are formulated as long as it
make a clear question.
• In 34 year old males with no chronic medical conditions
experiencing back pain (P), how do muscle relaxants
(I) compared to opioids (C) affect back pain (O)?
CLINICAL
SCENARIO
TYPES OF FOREGROUND QUESTIONS
SCENARIOS
PROGNOSIS QUESTION
CORRECT ANSWER
DIAGNOSIS QUESTION
CORRECT ANSWER
THERAPY/INTERVENTION QUESTION
CORRECT ANSWER
HARM/ETIOLOGY QUESTION
CORRECT ANSWER
PREVENTION QUESTION
CORRECT ANSWER

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EVIDENCE-BASED PRACTICE

• best research evidence

• Best research evidence

• Each type of question is best answered by different types of research studies.

The PICO framework can help you convert your clinical

The PICO framework can be used to break the problem

PICO element Relevant clinical

• Once the PICO elements are identified, then they need to be

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