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Evidence-Based Practice: What is EBP?

What is Evidence-Based Practice?

Evidence-based practice is the intersection of clinical expertise, research evidence, information from the practice context, and the patients values and circumstancesEvidence Based Practice was first defined by Dr David Sackett in the 1990s, but a more recent definition has it as

“integrating the best available research evidence with clinical expertise and the patient’s unique values and circumstances” (Straus, Glasziou, Richardson, & Haynes, 2011).

And "it also requires the health professional to consider characteristics of the practice context in which they work. " (Hoffman, Bennett, & Del Mar, 2017).

  • The best research evidence is usually from relevant research that has been carried out using sound methodology.
  • Clinical expertise is a combination of the clinician’s experience, education, and clinical skills.
  • The patient has his/her own personal preferences, concerns, expectations, and values.
  • The practice context includes characteristics of the situation in which the interaction between patient and health professional is taking place - for example, the resources available.

Evidence-Based Practice has been expanded from Evidence-Based Medicine to apply to other health professions and  other disciplines such as librarianship and education. This guide concentrates on (but is not exclusive to) EBP as it applies to the health professions.

Evidence-Based Practice vs Evidence-Informed Practice

A term that you might sometimes see used, especially in nursing research, is Evidence-Informed Practice. According to Woodbury and Kuhnke (2014), this term is used instead of, or as well as, evidence-based practice. They suggest that the term seems to give more flexibility regarding the nature of evidence and its use, “i.e., it implies that many different levels of evidence and types of evidence … are needed and used to support decisions in clinical practice.” (p. 29)

They also suggest that the terminology is less significant than the approach. “At the level of individual patients/ clients, it is important that clinicians know the unique values, preferences and circumstances of their clients in addition to the scientific evidence that supports and informs their practice”. (p. 29)

 

Hoffmann, T., Bennett, S., & Del Mar, C. (2017). Evidence-based practice across the health professions (3rd ed.). Elsevier Australia.

Straus, S. E., Glasziou, P., Richardson, W. S., & Haynes, R. B. (2011). Evidence-based medicine: How to practice and teach it (4th ed.). Churchill Livingstone Elsevier.

Woodbury, M. G., & Kuhnke, J. L. (2014). Evidence-based practice vs. Evidence-Informed Practice: What's the difference? Wound Care Canada, 12(1), 26-29.

The steps in EBP

The Evidence-Based Practice process is usually seen as having 5 steps:

Step 1 ASK Express the problem as a clinical question (Ask the question)
Step 2 ACQUIRE Find evidence-based resources that answer the question (Acquire the evidence)
Step 3 APPRAISE Critically appraise the evidence to assess its validity (Appraise the evidence)
Step 4 APPLY Apply the evidence (Apply the evidence to the patient(s) or problem)
Step 5 ASSESS/AUDIT Evaluate your performance in carrying out Steps 1 - 4 (Assess and audit the process)

 

Evidence-Based Practice is Not Just Randomised Controlled Trials

Hoffman, Bennett, and Del Mar, in their book Evidence-Based Practice across the health professions, point out that Evidence-Based Practice is not the same as randomised controlled trials:

"... it is certainly true that randomised controlled trials are the cornerstone of research investigating whether interventions (treatments) work. However, questions about the effectiveness of interventions are not the only type of clinical question ." (Hoffman, Bennett, & Del Mar, 2017).

Health professionals also need information about questions of:

  • aetiology - what causes disease
  • frequency - how often a disease or condition occurs
  • diagnosis - how we know if a client has a disease or condition
  • prognosis - what happens to a patient with a condition over time
  • the client's experiences and concerns.

It's possible that each question will require a different type of research design, and randomised controlled trials are just one type of research design. Others include:

  • qualitative research
  • case-control studies
  • cross-sectional studies
  • cohort studies.

Hoffman, Bennett, & Del Mar also point out that EBP is not the same as "guidelines". Rather, practice guidelines are "just one route to getting the best available evidence into clinical practice." (Hoffman, Bennett, & Del Mar, 2017).


Hoffmann, T., Bennett, S., & Del Mar, C. (2017). Evidence-based practice across the health professions (3rd ed.). Elsevier Australia.

More Resources

Tutorials

 

Website

  • Evidence Essentials
    An introduction to Evidence Based Medicine, clinical trials, and Cochrane evidence, from the respected Cochrane Collaboration. Designed for consumers, policy-makers, and healthcare professionals. Free, but you need to register.

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