0._Evidence_Informed_Practice

Evidence Informed Practice: Combines various types of evidence to improve decision-making and care.
- No single type of evidence represents the total truth.
- Components:
  - Expertise: Skills and knowledge derived from practice.
  - Research: Findings from academic studies.
  - Experience: Perspectives of people accessing services, families, and caregivers.

Definitions of Evidence:
1. Proof or grounds for belief that can either support or refute a claim.
2. Clear indications or signs about conditions or states.
Types of Evidence:
- Diagnosis, Test Results, Anecdotes.
- Published Literature, Conventional Wisdom, Literature Review.
- Clinical Opinion, Clinical Guidelines.

Available Evidence Types:
- Educational Materials, Clinical Experts, Physical Findings.
- Research Journals, Patient Insights, Clinical Experience.
Considerations: Clinicians must evaluate the strengths and limitations of each type of evidence selected.

Patient Values and Preferences: Influence the patient's choices regarding their healthcare based on personal beliefs and cultural factors.
Patient History and Medical Records: Document comprehensive past medical conditions, treatments, and family history.
Patient-Reported Outcomes (PROs): Insights from patients on their health, symptoms, quality of life, and perceptions of treatment effectiveness.
Patient Lifestyle Factors: Relevant lifestyle details that may impact health outcomes (diet, exercise, alcohol use).
Patient Adherence and Compliance: Information on the patient's following of prescribed treatments.
Symptom Diaries and Journals: Logs maintained by patients detailing their conditions and experiences over time.
Patient Experiences and Feedback: Qualitative data gathered from interactions with patients, aiding in understanding their care journey.

Three Aspects of the Model:
- Biological: Objective data such as examinations, lab findings, and imaging.
- Psychological: Subjective experiences including mood and expectations.
- Social: Cultural influences, support networks, and life circumstances affecting the patient.

Inclusion in Decision-Making: Engaging patients in their treatment plans leads to:
- Increased alignment with their preferences and values.
- Enhanced adherence to treatment.
- Higher overall satisfaction with care.

Methods to Inform Patients:
- Explanation of theoretical foundations, mechanisms of action, and literature references.
Engagement Contribution: Active patient participation is crucial for effective healing.

Definition: Involves the clinician's experiences and those of the broader profession.
Expertise Development: Gained through exposure, practice, and accumulated time, forming a foundation of evidence-informed practice.

Duration of Commitment: 20-40 years in practice leads to abundant insights.
Expertise Variation: Not all experience translates directly to expertise due to differences in practice, patient populations, and specialization.

Documentation Challenges: Clinical experience is often informal and passed on through mentorship.
Value of Experience: Greater authority correlates with more experience; clinician intuition plays a crucial role.

Components of Evidence:
- Clinical expertise, judgment, physical examination findings.
- Clinical intuition, case studies, and ongoing patient monitoring.
- Team-based knowledge sharing, treatment algorithms, practical considerations of resource availability.

Research Capabilities:
- Effectiveness of Interventions: Assesses the efficacy of treatments in different scenarios.
- Diagnostic Accuracy: Evaluates sensitivity and utility of diagnostic tests.
- Disease Understanding: Investigates disease causes and risk factors.
- Health Data: Looks at prevalence, outcomes, healthcare costs, and patient-reported satisfaction.

Subjective Questions: Values and morality are beyond empirical evidence.
Personalization Challenge: Individual patient experiences may not be fully captured in broader studies.
Complex Predictions: Forecasting future impacts in healthcare is often uncertain.
Holistic Health: Research may overlook comprehensive understandings of health including psychological and social dimensions.

Examples:
- General question of population representation vs specific inquiries about treatment benefits (e.g. spinal manipulation).
Consider the generalizability of research findings to individual patients.

Generalizability: Assess if patients fit the criteria of studies.
Protocol Alignment: Ensure the study protocols reflect actual treatment plans and patient goals.

Objective Approach: Aims to minimize bias and confounding factors.
Systematic Methods: Involves reproducibility and verifiability.
Statistical Analysis: Determines the probability of findings being coincidental.

Clinical Equipoise: Maintains genuine uncertainty about questions tackled.
Hypotheses Testing: Employs valid and reliable methodologies.
Peer Review Process: Ensures research authenticity and thorough examination of ethical considerations.

Continuous Development: Research findings can evolve, leading to changes in clinical practices over time.

Misleading Results: Risks associated with inadequate sample sizes, bias, and methodological flaws.

Awareness: Recognition of potential biases in research methodologies and the importance of rigorous study designs.

Research Gap: Estimates indicate a significant proportion of clinical treatments lack research validation.
Call to Action: Clinicians should possess skills to evaluate the validity and relevance of available research while synthesizing all evidence types on behalf of their patients.