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Evidence based decision making11/29/2023 Second, we argue that EBM has developed ways to try and balance researcher, practitioner and public knowledge, without compromising methodological rigour or privileging some perspectives over others. Drawing on this perspective, we present three key lessons from these debates for practitioners of EBM and EBP.įirst, that although the tools and practices developed by EBM (privileging RCTs and systematic reviews over practitioner discretion) and EBP (led by demands for evidence from political decision-makers) are different, there are opportunities for greater transparency about decision-making processes in policy. Instead, EBM is often presented as a practice where clinical decision-making is seen as a site of negotiation between different stakeholders, which include the (researcher-derived) evidence base, the clinician, the patient, and providers of care and services generally. These days, most sensible people agree that there are good reasons for research evidence not overruling clinical experience by default: for example, the incompleteness of the evidence base or that clinical and lay experience should be recognised as vital components in the decision-making process, alongside a range of research types (Head, 2010). This strict version is, however, a caricature. Critical commentators of EBP observe that ‘evidence-use’ is hard to diagnose and/or categorise (Parkhurst, 2017b Smith 2013a), that focusing on evidence-use risks ignoring most of the machinery of decision-making (Oliver et al., 2014), and that what needs addressing by researchers and practitioners of evidence-based decision-making, is the ‘human factor’ power, actors, and context (Freudenberg and Tsui, 2013 Oliver et al., 2012 Wesselink et al., 2014). It is immediately obvious that this strict version simply wouldn’t work for EBP, as it dismisses too much useful information, and does not take account of people’s experiences and values. However, advocates of EBP sometimes use an idealised template of EBM, which indicates that all policy/practice decisions should be predominantly based on research evidence–even that only some forms of research are ‘valid’ enough to support decision-making–the randomised controlled trial (RCT) and systematic review. Health care is getting more effective, and the proliferation of clinical guidelines to cover more and more of the changing face of clinical practice indicates the success of this institutional approach (Montori, 2008). Finally, we summarise the main answered, and unanswered questions for researchers and practitioners of evidence-based decision-making.Īdvocates of evidence-based policy (EBP) justifiably use evidence-based medicine (EBM) as a template for their activities. Here, we compare the two movements, and identify lessons for each (and their critics) to learn. At times, the EBM and EBP movements have developed in parallel. We draw on existing literature to outline the debates about the main challenges to the evidence-use movements, and the strategies used by advocates to address these challenges. This paper summarises how commentators and advocates have thought about evidence use in medicine and policy over the previous decades. We suggest that advocates of evidence use, and commentators, should focus on thinking about how the type of problem faced by decision-makers should influence what evidence is produced, sought, and used. Finally–and this is a lesson for EBM too–that understanding power is vital, and how it shapes how knowledge is produced and used. Secondly, to consider how to balance evidence and other interests, and how to assemble the evidence jigsaw. Firstly, to be more transparent about the processes and structures used to find and use evidence. We identify three lessons EBP could learn from EBM. These strategies allow EBM practitioners to effectively draw on useful evidence, be transparent, and be inclusive essentially, to share power. EBM has evolved over the last 70 years, and now tends to be methodologically pluralistic, operates through specific structures to promote EBM, and is inclusive of a wide range of stakeholders. Evidence-based medicine is often described as the ‘template’ for evidence-based policymaking.
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