Evidence Based Medicine (...healthcare)

You are working in a community team and a few of the CNSs consistently advise dexamethasone 8 mg od for non specific cancer related breathlessness. How would explain EBM to the team? How would you go about trying to incorporate EBM into the team?

“ Evidence-based medicine is the integration of best research evidence with clinical expertise and patient values” Sackett & Straus

Ask Access Appraise Apply Assess

Ask – convert the clinical puzzle into an answerable question Access Appraise Apply Assess

Ask Access – search to find the answer to that question Appraise Apply Assess

Ask Access Appraise – critically evaluating the evidence to decide if it is, and if so how, reliable and robust Apply Assess

Ask Access Appraise Apply – extract the useful information, address generalisability and patient concerns and decide what clinical action is needed Assess

Ask Access Appraise Apply Assess – keep a record, evaluate and improve the process

C Critically A Appraised T Topic B Best E Evidence T Topic

Ask the right question General question Patient characteristics Intervention or defining question Relevant outcome

Ask the right question General question Are corticosteroids helpful for breathlessness? Patient characteristics Intervention or defining question Relevant outcome

Ask the right question General question Are corticosteroids helpful for breathlessness? Patient characteristics In patients with cancer / palliative care patients Intervention or defining question Relevant outcome

Ask the right question General question Are corticosteroids helpful for breathlessness? Patient characteristics In patients with cancer / palliative care patients Intervention or defining question do corticosteroids Relevant outcome

Ask the right question General question Are corticosteroids helpful for breathlessness? Patient characteristics In patients with cancer / palliative care patients Intervention or defining question do corticosteroids Relevant outcome reduce breathlessness

Ask the right question General question Patient characteristics Intervention or defining question Relevant outcome

Levels of Evidence

BET A There is good evidence to support the use of the procedure B There is fair evidence to support the use of the procedure C There is poor evidence to support the use of the procedure D There is fair evidence to support the rejection of the procedure E There is good evidence to support the rejection of the procedure

Tips on EBM success Focus on actual learning needs Center around real clinical decisions Focus on applying research…not doing it Focus on interpreting statistics… not doing them Balance passive with active learning Research evidence adds to clinical expertise, patient values and circumstances Build lifelong learning abilities Humiliate SpRs for not knowing the answers already

Alternative Approaches to Medicine

Six factors influence the uptake of innovations 1.Relative benefit – what’s in it for me? 2.(non)-Complexity – is it easy to learn? 3.Trialability – can I try it out easily? 4.Observability – can I see others do it? 5.Compatability – fit with ideas and work 6.Reinvention – can I adapt it to me?