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A distinguishing feature and strength of EBP is the inclusion of multiple evidence sources. In addition to research evidence, clinicians can draw from a range of nonresearch evidence to inform their practice. Such evidence includes personal, aesthetic, and ethical ways of knowing (Carper, 1978)—for example, the expertise, experience, and values of individual practitioners, patients, and patients' families. In this chapter, nonresearch evidence is divided into summaries of evidence (clinical practice guidelines, consensus or position statements, literature reviews); organizational experience (quality improvement and financial data); expert opinion (commentary or opinion, case reports); community standards; clinician experience; and consumer preferences. This chapter:
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Describes types of nonresearch evidence
Explains strategies for evaluating such evidence
Recommends approaches for building clinicians' capacity to appraise nonresearch evidence to inform their practice
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Summaries of Research Evidence
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Summaries of research evidence such as clinical practice guidelines, consensus or position statements, integrative reviews, and literature reviews are excellent sources of information relevant to practice questions. These forms of evidence review and summarize all research, not just experimental studies. They are not themselves classified as research evidence because they are often not comprehensive and may not include an appraisal of study quality.
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Clinical Practice Guidelines and Consensus/Position Statements (Level IV Evidence)
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Clinical practice guidelines (CPGs), as defined by the Institute of Medicine (IOM) in 2011, are statements that include recommendations intended to optimize patient care that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care (IOM, 2011). CPGs are tools designed to provide structured guidance about evidence-based care, which can decrease variability in healthcare delivery, improving patient outcomes (Abrahamson et al., 2012).
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A key aspect of developing a valuable and trusted guideline is creation by a guideline development group representing stakeholders with a wide range of expertise, such as clinician generalists and specialists, content experts, methodologists, public health specialists, economists, patients, and advocates (Sniderman & Furberg, 2009; Tunkel & Jones, 2015). The expert panelists should provide full disclosure and accounting of how they addressed intellectual and financial conflicts that could influence the guidelines (Joshi et al., 2019). The guideline development group should use a rigorous process for assembling, evaluating, and summarizing the published evidence to develop the CPG recommendations (Ransohoff et al., 2013). The strength of the recommendations should be graded to provide transparency about the certainty of the data and values applied in the process (Dahm et al., 2009). The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) strategy is a commonly used system to assess the strength of CPG recommendations (weak or strong), as well as the quality of evidence (high, moderate, low/very low) they are based on (Neumann et al., 2016). For example, a 1A recommendation is one that ...