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Evidence-Based Practice

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Once the research and its results are validated, the next step is to integrate the evidence with your expertise, while also taking into account the patient’s values and expectations. Reflect on the following patient applicability questions in these areas:

Diagnosis

Patient Applicability

  • Is the test affordable and available to the patient?  

  • Will the diagnosis affect outcomes that matter to the patient, such as quality of life, mortality, disability, and cost?

Therapy/Intervention

Patient Application:

  • Were the results clinically significant in a tangible way that is of value to the patient or just statistically significant? 

  • Are you assessing whether the expected benefits of the intervention are meaningful and substantial for your patients? 

  • What is the quality of life with this treatment? Are there other treatments to compare?

  • Does the intervention align with the needs, values, and preferences of my patient or community?
  • Is my patient likely to follow the treatment requirements?

Harm

Patient Application:

  • Are you weighing the benefits against any possible adverse effects or complications?
  • How do the potential harms compare with the needs, values, and preferences of your patient?

Prognosis

Patient Application:

  • Are the results of tests useful for counseling patients?
  • Are you prepared to make adjustments based on patient responses and new evidence that may emerge?

Sources:

Papademetriou, V., Andreadis, E. A., & Geladari, C. (2019). The importance of applying evidence-based medicine in clinical practice. In Management of Hypertension: Current Practice and the Application of Landmark Trials (1st ed. 2019.). Springer International Publishing: Imprint: Springer. doi.org/10.1007/978-3-319-92946-0

University of Minnesota. (n.d.). Applying the evidence. In Evidence-Based Practice. Retrieved from https://pressbooks.umn.edu/evidencebasedpractice/chapter/applying-the-evidence/  

For more information:

Guyatt, G., Rennie, D., Meade, M. O., & Cook, D. J. (Eds.). (2014). Users’ guides to the medical literature: A manual for evidence-based clinical practice (3rd ed.). McGraw Hill Medical.

National Institute for Health and Care Excellence. (n.d.). Principles for putting evidence-based guidance into practice. Retrieved from https://intopractice.nice.org.uk/principles-putting-evidence-based-guidance-into-practice/index.html

Every medical intervention has potential risks and benefits. It is essential for the patient to fully understand the likelihood of the occurrence and how significant they might impact the patient's life. The use of effective practitioner communication strategies to move patients from mere knowledge to a fuller level of understanding (Freeman, 2019; NHS Scotland, n.d.)

Communication Strategies

  • Target and Tailor

    • Target the information you provide to the specific decision the patient needs to make, and tailor the information in order of importance.

  • Chunk and Check

    • The first step of Chunk and Check is to simplify complex information by breaking it down into smaller, manageable parts.  After presenting each chunk of information, take the time to discuss it with the patient to check understanding.

  • Teach Back Model:

    • After explaining a concept, ask patients to repeat the information in their own words. The Teach Back Model ensures they have understood correctly and allows you to clarify any misunderstandings.

  • Using Familiar Words:

    • Avoid medical jargon and use language that is familiar to the patient. This makes the information more accessible and less intimidating.

  • Refrain from Emotive Words:

    • Use neutral language to avoid causing unnecessary anxiety or fear. Using words alternative words for emotion-filled words can help keep the patient calm. (Incurable> not currently treatable; terminal illness> life-limiting condition; dying> in final stages of life) 

  • Integrate Numbers:

    • Use numerical data to explain risks and benefits, but ensure the numbers are presented in a way that is easy to understand. 
  • Graphics:
    • Utilize visual aids such as bar charts, icon arrays, risk ladders, and fact boxes to illustrate data. These tools can make complex information more digestible and visually engaging.
      • Most understandable graphics include Bar Charts, Icon Arrays (Pictographs), Risk Ladders (represent the likelihood of different outcomes on a vertical scale)

  • Relative & Absolute Risk: Use Context:

    • When discussing risks, provide both relative and absolute risk figures. Contextualize these numbers to help patients grasp the real-world implications of the data.

  • Out of X Rather Than ‘1 in…’:

    • Present probabilities using “out of X” instead of “1 in…” to make the statistics more relatable and easier to understand. For example, "1 in 100" can be abstract where using the words "Out of every 100 people"

  • Effectiveness vs. Failure Rate

    • Be mindful of how you frame information. Discussing the “effectiveness” of a treatment can be more reassuring than focusing on its “failure rate.”

  • Be Upfront About Uncertainties:

    • Clearly communicate any uncertainties or limitations in the data. Being transparent about what is known, and unknown helps build trust and allows patients to make informed decisions.

Sources:

Freeman, A. L. J. (2019). How to communicate evidence to patients. Drug and Therapeutics Bulletin, 57(11), 119-124. 10.1136/dtb.2019.000008

 

NHS Scotland. (n.d.). Health literacy place toolkit. Retrieved October 30, 2024, from https://www.healthliteracyplace.org.uk/toolkit/ 

Patient Education: Used to improve health outcomes, empower patients, and support self-management.

When giving patients resources, ensure the resources are accessible to them in terms of language, readability, cultural relevance, and digital access. Resources should be at an appropriate reading level, easily understood, and ideally offered in multiple formats (print, digital, audio) to accommodate different learning styles and needs. Additionally, verify that patients have the necessary technology and digital literacy if resources are provided online. Accessible resources help patients better engage with their own care and make informed decisions about their health.

  • MedlinePlus is a comprehensive online health information resource designed for patients, their families, and friends. It offers a wide range of topics, including:
    • Health conditions and wellness
    • Drugs and supplements
    • Medical tests
    • Genetics
    • Healthy recipes
    • Medical encyclopedia
  • MedlinePlus Connect is a free service allowing electronic health record (EHR) systems to link users to health information easily.
    • How It Works
      • Request Information: MedlinePlus Connect responds to requests based on diagnosis codes, medication codes, lab test codes, and procedure codes.
      • Receive Links: When a system submits a code, MedlinePlus Connect provides links to relevant patient education materials.
      • Access Options: Available as a web application or web service, in both English and Spanish.
  • UpToDate is an evidence-based clinical resource that offers comprehensive patient education resources designed to help patients and their families understand medical conditions and treatments.
    • Levels of Content
      • The Basics: Short overviews written in plain language, answering the most important questions a person might have about a medical problem.
      • Beyond the Basics: Detailed reviews for readers who want in-depth information and are comfortable with some medical terminology.