Step 5: Communication and Evaluation

Table of Contents Communication Communicate with Your Patients Video 1 Communicate with Health Professionals Evaluation Evaluate Yourself Video 2 How did you do? Video 3 Case Example 1 Case Example 2

Your results are important to: Your patients Other health professionals Yourself

Communication with Your Patients Critical to the success of practicing EBM The explanation of the best evidence in terms or risks, benefits, and alternatives is necessary for your patient to make an informed decision. Must be in terms that patients understand

Video 1 View movie as: –QuickTime (.mov)QuickTime (.mov) –Flash (.swf)Flash (.swf) Double-click on video for full- screen mode.

Communication with Other Health Professionals Part of the team approach to patient care May cause a colleague or an institution to change the standard way of practicing

Evaluation of Yourself Ask questions more appropriately Seek better solutions

Video 2 View movie as: –QuickTime (.mov)QuickTime (.mov) –Flash (.swf)Flash (.swf) Double-click on video for full- screen mode.

How did you do? Are you asking well-built clinical questions?asking well-built clinical questions Yes No

How did you do?: Developing an answerable question Do you need further background information? Yes No

Can you develop an answerable question?: Need further background info You may need to first ask background questions to gain some basic information and insight before proceeding with a foreground question.

How did you do?: Developing an answerable question Are you easily using one of the question structures given in step 1, such as PICO?step 1PICO Yes No

How did you do?: Developing an answerable question Are you having difficulty determining your target population, or relevant patient characteristics? Yes No

Developing an answerable question: Patients or population You would like to restrict patient variables to those similar to your patient and relevant to the outcome of interest. Uncontrolled variables may affect the outcome variable in ways that make it difficult to distinguish their effects from those of the intervention.

How did you do?: Developing an answerable question Are you struggling to include an intervention? Yes No

Developing an answerable question: Intervention You would like to see how differences in the intervention are likely to affect the outcome variable for your patient. Think about what differences may affect the outcome of interest. Use one of these for your intervention.

How did you do?: Developing an answerable question Are you having trouble incorporating a comparison group, or gold standard? Yes No

Developing an answerable question: Comparison You would like to compare the intervention you chose with the main alternative to it (another intervention, a placebo, nothing at all, etc.) If applicable, choose one of these. However, if this cannot or should not be done for ethical reasons, this component may be excluded from your question.

How did you do?: Developing an answerable question Are you straining to identify an outcome of interest? Yes No

Developing an answerable question: Outcome of interest You would like to observe measurable differences resulting from the effects of the intervention. What effects of interest do you expect the intervention to have?

Video 3 View movie as: –QuickTime (.mov)QuickTime (.mov) –Flash (.swf)Flash (.swf) Double-click on video for full- screen mode.

How did you do? Are you finding the best evidence available? Yes No

How did you do?: Finding the best evidence available Try different search engines. Use related words (i.e. synonyms, broader terms, etc.) separated by OR’s. Use truncated roots with wildcard characters to broaden your search.

How did you do? Are you efficient at finding the best evidence? Yes No

How did you do?: Efficiently finding the best evidence available Include more precise applicable terms and phrase separated by AND’s. Use whole phrases when appropriate. Use NOT’s to exclude unrelated articles. Add parentheses to maintain control over the order the words are processed in.

How did you do? Can you appraise your findings? Yes No

How did you do?: Appraising your findings Do you understand the Evidence Pyramid and why it is organized as it is? Can you understand the research methodologies that underlie these studies?

Case Example Question View movie as: –QuickTime (.mov)QuickTime (.mov) –Flash (.swf)Flash (.swf) Double-click on video for full-screen mode.

A Case Example If mammograpy is 90% sensitive and 95% specific, the chance that the patient has breast cancer is A. 1-5%B % C %D % E %

A Case Example The answer is 15%. See why

Case Example Answer View movie as: –QuickTime (.mov)QuickTime (.mov) –Flash (.swf)Flash (.swf) Double-click on video for full-screen mode.

How did you do? Are you becoming more accurate in applying some of the critical appraisal measures such as likelihood ratios, NNT, NNH, and relative risks?

How did you do? Can you integrate your findings to your patient?

How did you do? Are you able to communicate your results to your patient in a way to make him/her better informed?

How did you do? Are you able to justify why you did or did not follow a clinical decision based on integration of the evidence with an individual patient?

How did you do? Are you able to see development in quality improvement measures as a result of implementing EBM in daily practice?

Links to Other Websites and Hands-On Activities Evaluation Questions –from the Centre of Evidence Based Medicine

Congratulations! You have successfully completed step 5. The End