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Essence of Evidence-Based Medicine: A Case Report

From the Program in Evidence-Based Care, Cancer Care Ontario, and Health Information Research Unit, Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.

Address reprint requests to George P. Browman, MD, Health Information Research Unit, McMaster University Health Sciences Centre, 1200 Main St West, Room 3H7, Hamilton, Ontario, Canada L8N 3Z5.

ABSTRACT

PURPOSE: To illustrate the complexities of the evidence-based approach in clinical oncology practice and the implications for guidelines and evaluation of processes of care.

PATIENT AND METHODS: A case report is presented in which a limited systematic review of the literature was used to address a specific clinical problem in an individual patient. Experts' opinions were also sought.

RESULTS: A reasonable clinical decision was made by a participating patient based on indirect evidence of benefit that would be insufficient to support the same decision as a health policy in some jurisdictions.

CONCLUSION: The practice of evidence-based oncology requires clinical judgment about the validity and applicability of research evidence. The factors that influence an evidence-based decision in the clinical context differ from those in the broader policy context, which could lead to legitimate differences in recommendations based on the same information. Used properly, the individual case report can be a powerful tool to illustrate complex clinical decision phenomena.

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