Evidence Based Practice: A Case Study

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1. EBM has been around for years. Why is EBM so hard to implemet? According to Mohammad and Salahshoor (2018) “Despite the emergence and development of evidence-based practice (EBP) in recent years, its adoption continues to be limited.” (p. 25). By use of used Rogers's diffusion of innovation theory, they were able to identify several factors that affect the adoption of Evidence based medicine, including individual innovation, attitude, knowledge, and the perception of evidence based medicine. In my own experience, I have found that attitude of providers greatly affected their adoption of EBM. When providers feel they are losing control of the care of their patients or they feel that guidelines and evidence based practice are being force on them they are reluctant to adopt. There also is an art to medicine which sometimes is lost in the science. Many providers (myself included) are concerned that when we establish guidelines and protocol we can loose the human element of medicine and it is reduced to cook book medicine. I have seen providers follow guidelines with a blatant disregard to the patient right in front of them. EBM is like a GPS used properly , there are useful and helpful and allow us to get to where we need to be. Many people have gotten hopelessly lost because they followed a GPS and never bothered to look up and see where they are going. So too with evidence based medicine it is guide that must be used in conjunction with clinical judgment. …show more content…
In the Video, Dr. Abda point out the importance of not only using clinical research information but also rely of shared decision making, the patients values and preferences, and and the providers experience and expertise. 2. Discuss a change model that can be used such as Lewin’s or Kotter’s Model to implement EBM. McGarry (2012) reminds us that, “Kurt Lewin (1890-1947) was a seminal theorist of change, whose pioneering work has had significant impact across many disciplines” (p. 263). While there are various components tot Lewin …show more content…
RCT have however raise many ethical issues. One of these issues according Shamey (2015) is “How should clinicians decide whether it is ethically justifiable to enroll their patients into randomized clinical trials (RCTs)” ( p. 2). In the past it was felt that by blinding the study, providers would not know which treatment was given and that there was no way to determine if one treatment was better than the other. This was known as equipoise. Based on equipoise provider can ethically place patient in trials because they do not know which treatment is better. Today many providers have opinions about treatment and they are reluctant to place patient into trials because they feel one arm to be inforero to the other. Shamey discussed the concept of fallibility, where he points out that all provider opinions are sufficiently uncertain which therefore begs the need of the trial and enrolled therein. Another area of ethical concerns is what to do when the trials are leaning excessively one way or another. In the Early NSAB trial. 3 arms were established to determine the best treatment of breast cancer. Mastectomy, lumpectomy, or lumpectomy with radiation. The study early on showed such poor outcome in the lumpectomy only group that this arm of the trial was stopped early. The other too arms were completed and from this we know that the surgive of

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