Step 4: apply

At this stage in the EBP process, we have in our hands the best available research evidence that is relevant to the clinical question we formulated!

Personalise

We now need to take this research evidence and combine it with our own clinical expertise to answer the question in the context of the clinical environment and with consideration of the patient’s preferences. This brings together all the elements of EBP as shown in the EBP diagram:

From Satterfield et al (2009) Toward a Transdisciplinary Model of Evidence-based Practice. Millbank Quarterly 87(2): 368-390. (With permission)

Throughout all of these EBP steps, it is important to remember that the factors of best available research evidence, clinical expertise, patient’s preferences are given similar importance and emphasis. In other words, we do not rely heavily on any one of these factors, but take them all into account.

Once we get to this step, we might have a clear answer to our question based on the best available research evidence. However, when we discuss with the patient this research evidence and the answer to which it points, the patient may prefer a quite different answer.

For example, research may indicate that the patient should be monocularly occluded for at least three hours per day, but the patient is not keen on this idea and the practitioner knows that if this line is followed the patient may not occlude at all, so the practitioner prescribes two hours of daily occlusion.

At this Apply step, the clinical question formulated in step one should be fully answered. At the preceding step an answer was found on the basis of best available research evidence, but it is at this step that an answer is found with which the patient is comfortable and is likely to comply and which suits the clinical provision available.

In EBP Step 2: acquire, opens in a new window and Step 3: appraise, opens in a new window the practitioner searches for the highest quality, highest level (most reliable) research evidence relevant to the clinical question at hand.
In this context, clinical expertise is the knowledge and experience of the practitioner, which may have been acquired from education at undergraduate or postgraduate level, reading, observation, clinical experience and other aspects of practice and training. This expertise overlaps to some extent with research evidence, since research often forms the basis of education and clinical practice, but clinical expertise is accumulated from various sources, not only research.
In EBP, the patient is part of the clinical decision-making process. The practitioner communicates with the patient to understand any circumstances, preferences or concerns that affect the extent to which the patient will be happy with the clinical decision and will comply (or be able to comply) with any recommended treatment.
When EBP is applied, this is done in the context of the clinic or practice environment. There may or may not be facilities and attitudes that support EBP. For example, the practice might provide computers with internet access in each room so that practitioners are able to conduct searches of databases such as Cochrane quickly and easily. On the other hand, the practice might not have adopted EBP, and practitioners may not be encouraged to use the best available research evidence as a basis for clinical decision making.

EBP Process

See the resources page for Step 4: apply for information on putting this into practice.

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Step 4: apply

EBP Process