An evidence-based practice (EBP) is any practice that relies on scientific evidence for guidance and decision-making. Practices that are not evidence-based may rely on tradition, intuition, or other unproven methods. Evidence-based practices have been gaining ground since the formal introduction of evidence-based medicine in 1992, and have spread to the allied health professions, education, management, law, public policy, and other fields. In light of studies showing problems in scientific research (such as the replication crisis), there is also a movement to apply evidence-based practices in scientific research itself. Research into the evidence-based practice of science is called metascience.
The movement towards evidence-based practices attempts to encourage, and in some instances to force, professionals and other decision-makers to pay more attention to evidence to inform their decision-making. The goal of evidence-based practice is eliminate unsound or outdated practices in favor of more effective ones by shifting the basis for decision making from tradition, intuition, and unsystematic experience to firmly grounded scientific research.
History
For most of history, professions have based their practices on expertise derived from experience passed down in the form of tradition. Many of these practices have not been justified by evidence, which has sometimes enabled quackery and poor performance. Even when overt quackery is not present, quality and efficiency of tradition-based practices may not be optimal. As the scientific method has become increasingly recognized as a sound means to evaluate practices, evidence-based practices have become increasingly adopted.
One of the earliest proponents of EBP was Archie Cochrane, an epidemiologist who authored the book Effectiveness and Efficiency: Random Reflections on Health Services in 1972. Cochrane's book argued for the importance of properly testing health care strategies, and was foundational to the evidence-based practice of medicine. Cochrane suggested that because resources would always be limited, they should be used to provide forms of health care which had been shown in properly designed evaluations to be effective. Cochrane maintained that the most reliable evidence was that which came from randomised controlled trials.
The term "evidence-based medicine" was introduced in 1992. This marked the first evidence-based practice to be formally established. Some early experiments in evidence-based medicine involved testing primitive medical techniques such as bloodletting, and studying the effectiveness of modern and accepted treatments. There has been a push for evidence-based practices in medicine by insurance providers, which have sometimes refused coverage of practices lacking in systematic evidence of usefulness. It is now expected by most clients that medical professionals should make decisions based on evidence, and stay informed about the most up-to-date information. Since the widespread adoption of evidence-based practices in medicine, the use of evidence-based practices has rapidly spread to other fields.
More recently, there has been a push for evidence-based education. The use of evidence-based learning techniques such as spaced repetition can improve students' rate of learning. Some commentators have suggested that the putative lack of any conspicuous progress in the field of education is attributable to practice resting in the unconnected and noncumulative experience of thousands of individual teachers, each re-inventing the wheel and failing to learn from hard scientific evidence about 'what works'. Opponents of this view argue that hard scientific evidence is a misnomer in education; knowing that a drug works (in medicine) is entirely different from knowing that a teaching method works, for the latter will depend on a host of factors, not least those to do with the style, personality and beliefs of the teacher and the needs of the particular children (Hammersley 2013). Some opponents of EBP in education suggest that teachers need to develop their own personal practice, dependent on personal knowledge garnered through their own experience. Others argue that this must be combined with research evidence, but without the latter being treated as a privileged source.
Vs. tradition
Evidence-based practice is a philosophical approach that is in opposition to tradition. Some degree of reliance on "the way it was always done" can be found in almost every profession, even when those practices are contradicted by new and better information.
Some critics argue that since research is conducted on a population level, results may not generalise to each individual within the population. Therefore, evidence-based practices may fail to provide the best solution to each individual, and traditional practices may better accommodate individual differences. In response, researchers have made an effort to test whether particular practices work better for different subcultures, personality types etc. Some authors have redefined EBP to include practice that incorporates common wisdom, tradition, and personal values in alongside practices based on evidence.
Evaluating evidence
Evaluating scientific research is extremely complex. The process can by greatly simplified with the use of a heuristic that ranks the relative strengths of results obtained from scientific research called a hierarchy of evidence. The design of the study and the endpoints measured (such as survival or quality of life) affect the strength of the evidence. Typically, systematic reviews and meta-analysies rank at the top of the hierarchy while randomized controlled trials rank above observational studies, and expert opinion and case reports rank at the bottom. There is broad agreement on the relative strength of the different types of studies, but there is no single, universally-accepted hierarchy of evidence. More than 80 different hierarchies have been proposed for assessing medical evidence.
Applications of evidence-based practice
Medicine
Evidence-based medicine (EBM) is an approach to medical practice intended to optimize decision-making by emphasizing the use of evidence from well-designed and well-conducted research. Although all medicine based on science has some degree of empirical support, EBM goes further, classifying evidence by its epistemologic strength and requiring that only the strongest types (coming from meta-analyses, systematic reviews, and randomized controlled trials) can yield strong recommendations; weaker types (such as from case-control studies) can yield only weak recommendations. The term was originally used to describe an approach to teaching the practice of medicine and improving decisions by individual physicians about individual patients.[10] Use of the term rapidly expanded to include a previously described approach that emphasized the use of evidence in the design of guidelines and policies that apply to groups of patients and populations ("evidence-based practice policies").
Whether applied to medical education, decisions about individuals, guidelines and policies applied to populations, or administration of health services in general, evidence-based medicine advocates that to the greatest extent possible, decisions and policies should be based on evidence, not just the beliefs of practitioners, experts, or administrators. It thus tries to assure that a clinician's opinion, which may be limited by knowledge gaps or biases, is supplemented with all available knowledge from the scientific literature so that best practice can be determined and applied. It promotes the use of formal, explicit methods to analyze evidence and makes it available to decision makers. It promotes programs to teach the methods to medical students, practitioners, and policymakers.
A process has been specified that provides a standardised route for those seeking to produce evidence of the effectiveness of interventions. Originally developed to establish processes for the production of evidence in the housing sector, the standard is general in nature and is applicable across a variety of practice areas and potential outcomes of interest.
Mental Health
Not all mental health practitioners receive training in evidence-based approaches, and members of the public are often unaware that evidence-based practices exist. Consequently, patients do not always receive the most effective, safe, and cost-effective treatments available. To improve dissemination of evidence-based practices, the Association for Behavioral and Cognitive Therapies (ABCT) and the Society of Clinical Child and Adolescent Psychology (SCCAP, Division 53 of the American Psychological Association) maintain updated information on their websites on evidence-based practices in psychology for practitioners and the general public. An evidence-based practice consensus statement was developed at a summit on mental healthcare in 2018. As of June 23, 2019, this statement has been endorsed by 36 organizations.
Social policy
There are increasing demands for the whole range of social policy and other decisions and programs run by government and the NGO sector to be based on sound evidence as to their effectiveness. This has seen an increased emphasis on the use of a wide range of Evaluation approaches directed at obtaining evidence about social programs of all types. A research collaboration called the Campbell Collaboration has been set up in the social policy area to provide evidence for evidence-based social policy decision-making. This collaboration follows the approach pioneered by the Cochrane Collaboration in the health sciences. Using an evidence-based approach to social policy has a number of advantages because it has the potential to decrease the tendency to run programs which are socially acceptable (e.g. drug education in schools) but which often prove to be ineffective when evaluated.
Scientific research
As with other fields, many practices in scientific research are rooted in tradition rather than evidence, and are unproven. John Ioannidis 2005 paper "Why most published research findings are false" found evidence that these poor practices regularly result in false findings and enormous waste. The paper was the most downloaded in the Public Library of Science, and has the highest number of Mendeley readers across all science." There has since been a movement for the use of evidence-based practice in conducting scientific research in attempt to address the replication crisis and other major issues affecting scientific research. The application of evidence-based practices to research itself is called metascience.
Metascience seeks to increase the quality of scientific research while reducing waste. It is also known as "research on research" and "the science of science", as it uses research methods to study how research is done and where improvements can be made. The five main areas of research in metascience are methodology, reporting, reproducibility, evaluation, and incentives. Metascience has produced a number of reforms in science such as the use of study pre-registration and the implementation of reporting guidelines with the goal of bettering scientific research practices.
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