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XXV. Evidence-Based Medicine: Principles for Applying the Users' Guides to Patient Care

Gordon H. Guyatt, MD, MSc; R. Brian Haynes, MD, PhD; Roman Z. Jaeschke, MD, MSc; Deborah J. Cook, MD, MSc; Lee Green, MD, MPH; C. David Naylor, MD, PhD; Mark C. Wilson, MD, MPH; W. Scott Richardson, MD; for the Evidence-Based Medicine Working Group

JAMA. 2000;284:1290-1296.

This series provides clinicians with strategies and tools to interpret and integrate evidence from published research in their care of patients. The 2 key principles for applying all the articles in this series to patient care relate to the value-laden nature of clinical decisions and to the hierarchy of evidence postulated by evidence-based medicine. Clinicians need to be able to distinguish high from low quality in primary studies, systematic reviews, practice guidelines, and other integrative research focused on management recommendations. An evidence-based practitioner must also understand the patient's circumstances or predicament; identify knowledge gaps and frame questions to fill those gaps; conduct an efficient literature search; critically appraise the research evidence; and apply that evidence to patient care. However, treatment judgments often reflect clinician or societal values concerning whether intervention benefits are worth the cost. Many unanswered questions concerning how to elicit preferences and how to incorporate them in clinical encounters constitute an enormously challenging frontier for evidence-based medicine. Time limitation remains the biggest obstacle to evidence-based practice but clinicians should seek evidence from as high in the appropriate hierarchy of evidence as possible, and every clinical decision should be geared toward the particular circumstances of the patient.

Author Affiliations: Departments of Clinical Epidemiology and Biostatistics (Drs Guyatt, Haynes, and Cook) and Medicine (Drs Haynes and Jaeschke), McMaster University, Hamilton, Ontario; Department of Medicine and Office of the Dean, Faculty of Medicine, University of Toronto, Ontario (Dr Naylor); Department of Family Medicine, University of Michigan, Ann Arbor (Dr Green); Department of Medicine, Wake-Forest University School of Medicine, Winston-Salem, NC (Dr Wilson); and Departments of Ambulatory Care and Research, South Texas Veterans Health Care System and Medicine, University of Texas Health Sciences Center, San Antonio (Dr Richardson).
The original list of members with affiliations appears in the first article of the series (JAMA. 1993;270:2093-2095). A list of new members appears in the 10th article of the series (JAMA. 1996;275:1435-1439). The following member of the Evidence-Based Medicine Working Group contributed to this article: Anne Holbrook, MD, MSc.

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