Integrate Evidence With Clinical Expertise and Patient Preferences and Values
Nursing is often referred to as both an art and a science. Evidence-based practitioners must combine understanding the science of health, illness, and disease with the art of adapting care to individual patients and situations, all while thinking critically to improve patient outcomes (see Figure 1).
Applying the best evidence to our clinical decision making involves examining, critiquing, and synthesizing the available research evidence. However, we must consider the science along with our clinical experience and patients’ values, beliefs, and preferences. In this article we’ll discuss how to incorporate patient preferences and clinical judgment into evidence-based decision making.
Good clinical judgment integrates our accumulated wealth of knowledge from patient care experiences as well as our educational background. We learn quickly as healthcare professionals that one size does not fit all. What works for one patient with fatigue may not work for another. What we can do is draw from our clinical expertise and past experiences to inform our decisions going forward. Our clinical expertise, combined with the best available scientific evidence, allows us to provide patients with the options they need. Patients can’t have a preference if they aren’t given a choice, and they can’t make that choice if they aren’t presented with all options.
Patient Preferences and Values
When we talk about including patient preferences in treatment and care decisions, what does this mean? Patient preferences can be religious or spiritual values, social and cultural values, thoughts about what constitutes quality of life, personal priorities, and beliefs about health. Even though healthcare providers know and understand that they should seek patient input into decisions about patient care, this does not always happen because of barriers such as time constraints, literacy, previous knowledge, and gender, race, and sociocultural influences.
However, we can learn tools and techniques to help elicit patient preferences. First and foremost, we must listen to our patients. Developing our own interpersonal skills is important in enabling us to have a conversation with patients and not just deliver information. We should also involve family members if patients desire. The ASK (AskShareKnow) Patient–Clinician Communication Model is a tool to teach patients and families three questions to ask their healthcare providers to get information they need to make healthcare decisions.
- What are my options?
- What are the possible benefits and harms of those options?
- How likely are each of those benefits and harms to happen to me, and what will happen if I do nothing?
The ASK model was tested to introduce the questions to patients before they met with their healthcare providers. The result was that patients asked one or more of the questions to their provider during their visit, and they also recalled the questions weeks later.
Using the best-available scientific evidence by itself is not enough to care for our patients in an evidence-based environment. We must also incorporate our clinical expertise and patient preferences and values to include the art with the science to see patient outcomes improve.