Evidence-Based Medicine: Review and Practice
Patient values, clinical expertise, information from the practice context, and the best research evidence all contribute to helping you make a clinical decision.
Evidence is produced in a way that gives an estimate of benefits and harms on a specific population. A variety of factors can affect the applicability of an intervention to a specific patient, including patient factors or patient and clinician adherence to the treatment . Some biological patient factors include Sex, Comorbidities, Race, Age, and Pathology (an acronym known as SCRAP). You'll also need to translate the relative risk or benefit into the absolute risk or benefit for your patient.
Shared decision-making means considering and working with the patient to make sure the treatment applies to them- that the patient has access to a treatment, can receive the benefits of a treatment and avoid harms as much as possible, and has the support structures needed to adhere to treatment. "It is very important to use shared decision-making to make sure that for this patient that general recommendation applies, that in their context they can implement that, and to figure out if they need additional support to do it in a safe manner" (Montori).