Examining the facts to improve care

There are differing views on what is meant by the term ‘evidence’ and its value, types and sources in the context of evidence-based health care. [1,2] The Canadian Health Services Research Foundation (2005) developed the following definition that reflects many considerations around evidence.

Evidence

Evidence is information that comes closest to the facts of a matter. The form it takes depends on the context. The findings of high-quality, methodologically appropriate research are the most accurate evidence. Because research is often incomplete and sometimes contradictory or unavailable, other kinds of information are necessary supplements to or stand-ins for research. The evidence base for a decision is the multiple forms of evidence combined to balance rigour with expedience – while privileging the former over the latter. [3]

What is the role of evidence?


Goal
Role of Evidence
Research Creation of new knowledge and/or use of existing knowledge in a new way to generate new concepts, methodologies, inventions, and understanding. [4]
Research outcomes and other sources of information where needed that come closest to the facts form evidence.
Evidence Based Practice (EBP) Evidence-based health care combines the best available evidence, clinical situation of the patient, patient preferences and actions, all bound together by clinical experience. [5] 
 Evidence tells us the right thing to do, that is, what is needed to solve the problem or issue. [6]
Quality Improvement (QI) Improve the quality of care delivery processes and outcomes by ensuring the right things are done. [6]
Evidence informs us of options to achieve what we know is needed to improve care processes. [6]
Knowledge Translation (KT) Processes and strategies ensuring access to evidence, understanding of evidence, and benefit from evidence. [7]
Evidence is the knowledge being transferred. [7]


How the context of palliative care influences the evidence and CareSearch content

Palliative care is a rapidly evolving, multidisciplinary field of practice. The types of evidence and knowledge produced within palliative care are accordingly varied and encompass many different types of research methodologies. Specific problems in research in the palliative care setting make some research exceedingly difficult to do, so that some study designs we might like to use to answer important questions relating to practice may never be available to us. The broad definition of the concept of evidence provided by Canadian Health Services Research Foundation accommodates the needs of palliative care.

An evidence-based approach is one which turns to the evidence to answer clinical and service-related questions and uses the best available evidence to do so. It involves appraising the quality of the evidence being used and acknowledges the strength of the evidence for decision making.

In practice, this means that CareSearch:

  • Includes many different types of research and evidence, and applies appropriate standards to each to assess their quality
  • Has developed a quality assurance process that is up-front and transparent, so that basic standards of evidence are met before a resource, link or reference is included in the site
  • Refers practitioners back to the literature to further explore most of the issues covered, and also provides pre-written PubMed literature search strategies for many important topics
  • Identifies areas of uncertainty in the literature, and gaps in the evidence base.

  1. Lomas J, Culyer T, McCutcheon C, McAuley L, Law S. Conceptualizing and combining evidence for health system guidance (492kb pdf). Ottawa: Canadian Health Services Research Foundation; 2005 May.
  2. Aoun SM, Kristjanson LJ. Challenging the framework for evidence in palliative care. Palliat Med. 2005 Sep;19(6):461-5.
  3. Canadian Health Services Research Foundation (CHSRF). Annual report 2005. Ottawa: CHSRF; 2005. p. 9.
  4. Australian Code for the Responsible Conduct of Research 2018. Canberra: National Health and Medical Research Council, Australian Research Council and Universities Australia. Commonwealth of Australia; 2018.
  5. Van den Block L, Vandevoorde J. Evidence-Based Practice in Palliative Care. In: MacLeod R, Van den Block L. editors. Textbook of Palliative Care. Cham, CH: Springer; 2019. https://doi.org/10.1007/978-3-319-77740-5_111
  6. Glasziou P, Ogrinc G, Goodman S. Can evidence-based medicine and clinical quality improvement learn from each other? BMJ Qual Saf. 2011 Apr;20 Suppl 1(Suppl_1):i13-17.
  7. Barwick M, Dubrowski R, Petricca K. Knowledge translation: The rise of implementation [Internet]. Washington, DC: American Institutes for Research; 2020. [updated 2022 May 17; cited 2022 May 19]

Useful resources

Read the US based National Cancer Institute's statement on palliative care evidence

Read this article on thinking outside the box for palliative care evidence

Visit McMaster University to learn about the 6S Pyramid for clinicians

Page updated 06 April 2022

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