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Introduction to EvidenceInformed Decision Making
(EIDM)
Laura Banfield, Nursing Librarian
Health Sciences Library
September 2010
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Learning Objectives
•Review the definition of Evidence (Informed) Based
Practice and the steps in the process
•Formulate questions using PICO and PS models
•Introduce the concept of preprocessed evidence and
the hierarchy of evidence
•Identify databases and sources for locating preprocessed evidence
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Evidence-Informed Decision Making
(EIDM)
“The integration of best research evidence
with clinical expertise and patient values to
facilitate clinical decision making”
(Sackett et al., 2000)
Clinical state,
setting, and
circumstances
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Clinical Decisions
Patient
preferences
and actions
ClinicalExpertise
Expertise
Clinical
Research
evidence
Health care
resources
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Steps of EIDM
1. Construct a relevant, answerable question from
a clinical case.
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2. Search the literature to retrieve the best
evidence.
3. Critically appraise the literature (evidence) for
validity and applicability.
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4. Apply the evidence to your clinical practice.
5. Evaluate the outcome or performance.
*From: Flemming, K. (1998). Asking answerable questions. Evidence-Based Nursing, 1(2),
36-7.
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Steps of EIDM
1. Construct a relevant, answerable question
from a clinical case.
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2. Search the literature to retrieve the best
evidence.
3. Critically appraise the literature (evidence) for
validity and applicability.
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4. Apply the evidence to your clinical practice.
5. Evaluate the outcome or performance.
*From: Flemming, K. (1998). Asking answerable questions. Evidence-Based Nursing, 1(2),
36-7.
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Asking Clinical Questions
Two Types of Clinical Questions:
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1. Background
2. Foreground
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Background & Foreground
Questions
Background questions are:
• general in nature
• address gaps in background knowledge
• examples include: pathophysiology, or risk factors of a
disease; an overview of a nursing theory
Foreground questions are:
• focused on the particular patient scenario, and
• ask for specific knowledge to manage the patient
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Background & Foreground
Questions
Background questions
• Need to be answered first
• Can be answered by books or general Websites
Foreground questions
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•Need to be very focused
•Can be answered by searching journal databases
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Background & Foreground
Questions
Examples of Background questions:
• What is the mechanism of action of insulin?
• How do you conduct a neurological assessment?
Examples of Foreground questions:
• Is exercise more effective than a low-fat diet in reducing
blood pressure in hypertensive patients?
• Is there a relationship between cell phone use in adults
and the incidence of brain tumors?
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Two Major Research ‘Categories:’
Quantitative Research
&
Qualitative Research
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Two Major Research
‘Categories’
Quantitative Research is an “objective, systematic
process to describe and test relationships and,
examine cause and effect interactions among
variables” (Burns & Grove, 1993, p. 777)
Qualitative Research is a systematic, subjective
approach used to describe life experiences and give
them meaning” (Burns & Grove, 1993, p. 777)
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Quantitative Research
•Goal is the discovery of relationships, or causation
(cause & effect).
•Based on scientific method (hypothesis formation and
testing)
•Many quantitative designs compare two or more groups
•Often involves an element of control
•Objectivity (related to measurement)
•Collection of data (numerical) and analysis via statistics
Burns & Groove, 1993; Roberts & Burke, 1989
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Quantitative Research Studies
Studies focus primarily on one of the following:
•Therapy/Treatment/Intervention; Prevention and
Control – Effectiveness
•Etiology/Causation/Harm
•Prognosis – Outcome
•Diagnosis and Screening/Assessment
•Economics
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Quantitative Research
Designs
Quantitative research designs (studies)
include:
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• Randomized Controlled Trials (RCTs)
• Cohort Study (Cohort Analytic)
• Case-Control Study
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• Cross-Sectional Study (survey)
• Case Report or Study
Greenhalgh, 1997
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Formulating the Question
(Quantitative)
P -- Population/Situation
I -- Intervention/Exposure
C -- Comparison/Counter Exposure
O -- Outcome
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Question
Intervention
Is exercise more effective than rest
for relieving chronic back pain?
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Question
Population
Intervention
Comparison
Outcome
People with back pain
Exercise
Bed rest
Reduced pain
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Question
Causation
Does the presence of hand sanitizer
stations in nursing homes reduce the
number of infections transferred to
residents?
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Question
Population
Exposure
Comparison
Outcome
Nursing home residents
Hand sanitizer stations
No hand sanitizer
Reduced infection
• Aim is to discover meaning or gain understanding of a
phenomena
• Investigates a phenomena in-depth
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Qualitative Research
Roberts & Burke (1989)
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Qualitative Research
•How people feel or experience a certain situation or
circumstance
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•Sampling of a small group of people
•Data collected via in-depth unstructured interviews,
observation, focus groups, diaries
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•Analysis of findings in narrative format
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Qualitative Research
Examples of qualitative research designs include:
• Phenomenology
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Examine the ‘lived experience” of individuals experiencing a
phenomena
• Grounded Theory
•
Goal is to understand a social-psychological process and
develop a theory
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• Ethnography
•
Study of a group or culture within their own setting
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Formulating the Question
(Qualitative)
P -- Population
S -- Situation
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Question
How do people with HIV/AIDS living in a rural
community feel about disclosing their status to
their health care provider?
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Question
Population
Situation
People with HIV/AIDS
Disclosing their status
to their health care
providers
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Hierarchy of
Pre-processed Evidence
(Haynes, 2007)
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Systems
Support clinical decision making through linking all
relevant best research evidence about a clinical situation
directly to a patient’s record.
(Haynes 2008)
Sources of Systems
•Integrative Electronic Patient Records
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Summaries
“Summaries integrate best available evidence from lower
layers … to provide a full range of evidence concerning
management options for a given health problem.”
(Haynes, 2007)
Sources of Summaries
•Clinical Practice Guidelines
•Evidence Based Texts
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Syntheses:
Systematic Reviews
Consolidate the literature on a specific topic:
• comprehensive identification of studies
• review of study relevance
• evaluate methodologic quality
• extraction and analysis of data
• draw of conclusions
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Sources of Synthesis
•The Cochrane Library
•Health Care Journals
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Synopses
“Synopses of individual studies or systematic
reviews encapsulate the key methodologic
details and results required to apply the
evidence to individual patient care.”
(Haynes, 2001)
Sources of Synopses
• Database of Abstracts of Reviews of Effects (DARE)
• health-evidence.ca
• Evidence-based abstraction journals
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Single Studies
Single Studies are used:
• To keep up with the literature
• To update summaries and systematic
reviews
• To contribute to clinical decisions if no
higher preprocessed level is available
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Sources of Single Studies
•CINAHL
•Medline
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EBN Resources Page
http://hsl.mcmaster.ca/resources
/topic/eb/nurse.html
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Library Sessions
Dates to be announced…