RACP - Measurement and Review >> Identification and agreement on the evidence base for better practice >> b. Defining and categorizing evidence

Measurement and Review >> Identification and agreement on the evidence base for better practice

b. Defining and categorising evidence

The evidence-based that informs the practice of each clinical discipline represented within your multidisciplinary team may come from differing research paradigms.

Within medicine, Evidence-Based Medicine (EBM) is the accepted approach for systematically defining evidence and categorising it into various levels according to the strength of the evidence. The strongest level of evidence in the EBM model is that generated through systematic review of multiple randomised controlled trials (RCTs).

The RCT approach suits some aspects of medical practice such as prescribing, but not others. For example, analysing effective communication may not be suited to the RCT method for various ethical or practical reasons.

In addition, the intensity with which the RCT approach has been applied across different sub-disciplines within medicine varies. For example in sub-disciplines in which practice is predominantly procedural, such as surgery, the RCT approach contrasts with that in oncology where most of the evidence base has been derived from stringent clinical trials.

For other clinical disciplines, such as nursing and allied health, the qualitative nature of the evidence base informing much of their practice may not always fit easily into the EBM classification framework, with its emphasis on RCTs.

Your team may spend some time reaching agreement on the evidence base to inform multidisciplinary practice.

Example
People were at different stages with the whole evidence-based practice genre. It may have been more useful to run workshops on what evidence-based practice is and how you go about it. Monash University Consortium.

If the project decides to focus only on systematic reviews of RCTs it may reduce the incentive for disciplines whose evidence base is not derived in this manner to be involved.

The evidenced base needs to be agreed by the multidisciplinary team. If priorities are skewed too heavily towards one clinical discipline, there is a risk that other disciplines will disengage from the project. Try to ensure that there is at least one indicator for each major discipline involved in your project, i.e. there is something for everybody.