Reducing Diagnostic Uncertainty: The Role of Evidence-Based Practices (EBP) in Clinical Practice and Research
Gordon J. Chelune, PhD, ABPP-CN Professor Emeritus, Department of Neurology, University of Utah School of Medicine
Within the clinical setting, the primary goal of any evaluation is to reduce clinical uncertainty about a patient’s diagnosis, management or care. While clinical research often attempts to answer questions designed to assist clinicians in making informed decisions about patients, many studies fail to provide key details that can inform the clinician as to the quality and applicability of the investigational findings for individual clinical decision making. Even when present, practitioners often have difficulty applying the information that is available in an evidence-based manner. EBP provides a framework for doing this in an empirical and systematic way that incorporates findings from critically appraised clinical research to inform decisions about individual patients. EBP begins with asking appropriate and answerable questions, using informatics skills to acquire relevant research information, and then critically appraising the information. The next step in the EBM process, applying the information, presents the greatest challenge for researchers and clinicians alike- that is, how does one present and use data derived from the study of groups to inform clinical decisions about individuals? After looking closely at the initial steps in the EBM process, this presentation will focus on methods for extracting relevant information from test manuals and research reports on patient groups and how to evaluate this information in terms of test operating characteristics (e.g., how to interpret odds and risk ratios, likelihood ratios, and other base-rate information), and most importantly how to apply these data derived from patient groups to individual patients in daily practice
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