What does a pandemic mean for Evidence Based Practice?

EBP Triad. Source of image: https://hsl.lib.unc.edu/services/evidence-based-practice-resources

“Evidence Based Practice (EBP) is the integration of clinical expertise, patient values, and the best research evidence into the decision making process for patient care.” (Sackett D, 2002)

It is a very difficult and emotional time. Everyone is trying to do the best for their patients. We, human, usually have a bias to do something to help.

Remember Hippocratic Oath:“… abstain from whatever is deleterious and mischievous.”

The questions are: Are we suspending its use as EBP doesn’t apply at a time like this? Adapting our exceptions of the evidence, but holding to the principles? Standing firm, nothing changes?

EBM Pyramid

Given the severity and urgency of the situation, we may have to accept lower levels of evidence to make the best informed decision at the time:

+ Expert opinion

+ Case studies

+ In vitro data

+ Open label trials

However, we still keep EBP principles and require solid evidence before we support using a drug.

While we may be accepting lower levels of evidence, we shouldn’t be accepting:

– Items that are not actually evidence

– Only expert opinion evidence as direction

Bottom line

Clinicians, politicians, and the public are desperate for hope, and that appears to lead us to move away from EBP into practice guided by emotions and feelings.

It is important that we do not give in to non evidence-based calls to embrace unproven therapies. Though it is very tempting to ignore core principles in this time of uncertainty and fear, the appropriate way to protect patients is to stay grounded in evidence and to fight misinformation. Bringing objective information to discussions helps reduce emotion and focus the discussion on solutions.

References

1. Slobodan J. Evaluating Evidence for Emerging Therapies during a Pandemic. Alberta Health Services. April 2, 2020. Accessed May 19, 2020.
2. Keijzers G, Cullen L, Egerton-Warburton D, Fatovich DM. Don’t just do something, stand there! The value and art of deliberate clinical inertia. Emerg Med Australas. 2018;30(2):273‐278. doi:10.1111/1742–6723.12922.
3. Braithwaite RS. EBM’s Six Dangerous Words. JAMA. 2020;323(17):1676–1677. doi:10.1001/jama.2020.2855.