Explain why patient values and clinical judgment must be considered before applying evidence in clinical decision making.

NUR699 Explain why patient values and clinical judgment must be considered before applying evidence in clinical decision making.

NUR699 Evidence Based Practice Project

Week 4 Discussion

DQ2 Evidence-based interventions often involved patient care. Explain why patient values and clinical judgment must be considered before applying evidence in clinical decision making for individual patients.

ORDER NOW FOR AN ORIGINAL PAPER ASSIGNMENT:NUR699 Explain why patient values and clinical judgment must be considered before applying evidence in clinical decision making.
The first decades of Evidence Based Medicine (EBM) were devoted to developing the science of clinical epidemiology and improving the technical means of applying its principles and tools consistently and efficiently. The underpinning research base has been built by refining systematic, rule-bound approaches such as health technology assessment (HTA) [1], comparative effectiveness studies [2], systematic literature review [3], and by ensuring rigorous standards for reporting such studies.

NUR699 Explain why patient values and clinical judgment must be considered before applying evidence in clinical decision making for individual patients.
NUR699 Explain why patient values and clinical judgment must be considered before applying evidence in clinical decision making.

These approaches are academically defensible and reproducible but can also be painfully arcane in their procedural and technical detail. Many clinicians have appreciated the increasingly impressive armoury of tools developed to support the practice of EBM but have felt simultaneously overwhelmed by their imperatives. The strong (and perhaps necessary) focus on technical procedure – how to do ‘robust’ research, how to synthesise data from primary studies, how to apply the findings in practice – has created the impression that EBM and its underpinning methodologies are concerned exclusively with matters of fact in an objective scientific environment, with confounders and bias either eliminated or carefully controlled for.

In this paper, we develop an argument which builds on the work of some of the early critics of EBM and draws on philosophical and sociological writings to suggest that the methodological rules of EBM, and the research that underpins them, are laden with largely unacknowledged values. In doing so we explore in detail the meaning of the term values. The protagonists of EBM have long recognised that patient values and circumstances must be taken into account when making clinical decisions.