Evidence-based practice (EBP) is an approach to care that encourages clinicians to use the best available evidence in combination with the individual patient’s circumstances and preferences in clinical practice. Sackett, Rosenberg, et al highlighted the essential aspects of evidence based medicine in their 1996 overview Evidence based medicine: what it is and what it isn't. (544kb pdf) Providing an evidence-based approach to clinical care requires the health professional to be able to:
- Understand the relationships between research and strength of evidence
- Access and appraise evidence
- Determine its applicability with regard to a particular patient’s context and wishes.
For palliative care, as with other disciplines, the development of evidence-based practice requires access to good quality and relevant evidence. Locating relevant evidence can be challenging. As this is a multidisciplinary field of practice, the literature and evidence base for palliative care can be complex with potentially useful material in many journals and bibliographic databases making identification and retrieval difficult. Clinical issues may not yet have been the subject of targeted research for a palliative population leaving clinicians reliant on evidence of uncertain relevance. Qualitative investigations are common in many of the disciplines that contribute to palliative care and they can utilise different methodologies and approaches. This can add to the complexities in comparing and combining studies.
As this is a referral based discipline supporting many different disease groups, there can be specific issues relating to the transferability and generalisability of evidence between sites of care delivery, underlying disease processes and patient groups. Its focus on quality of life as an outcome rather than cure also means that there must be a clear understanding of patient wishes and preferences that align with the best available evidence on treatment options in determining the plan for care.