Evidence Based Practice and Patient Needs

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Introduction

Step one of the evidence based practice (EBP) model is to determine the needs of the patient to formulate a clinical question. This step involves assessing the patient and determining the extent of their condition, their values and beliefs, and their specific context and preferences. All of this information will be useful in formulating the clinical question. This step correlates with the Ask component of the 5 A’s of EBP.

Interview principles

Patient-centredness is defined as: “Health care that establishes a partnership among practitioners, patients and their families… to ensure that decisions respect patients’ wants, needs, and preferences and that patients have the education and support they need to make decisions and partipate in their own care.”  Edgman-Levitan S, Schoenbaum SC. Patient-centered care: achieving higher quality by designing care through the patient’s eyes. Israel Journal of Health Policy Research. 2021 Dec;10:1-5.

Patient-centredness is positively associated with:

Patient satisfaction

Well-being

Adherence

Health behaviour

Knowledge about medical condition and recovery rate

In an assessment of patient perspectives on patient-centredness the following aspects are noted as most important to patients: Zeh S, Christalle E, Zill JM, Härter M, Block A, Scholl I. What do patients expect? Assessing patient-centredness from the patients’ perspective: an interview study. BMJ open. 2021 Jul 1;11(7):e047810.

Being taken seriously

Receiving competent treatment with empathy

Being recognised as individuals in in exceptional circumstances

Enough time during treatment sessions

Timely access to care

Non-verbal communication

This includes aspects such as:

Eye contact

Posture

Tone of voice

Head nods

Gestures

Postural positions

In cases where verbal and non-verbal messages contradict each other, non-verbal communication tends to outweigh the verbal message. Empathy and emotion are communicated more distinctively via non-verbal communication than verbally, making good non-verbal communication an integral, often overlooked part of the medical interview. Empathy is expressed by acting warm, friendly and reassuring, and has been linked with better patient satisfaction and recovery rates, and subsequently better health outcomes. Vogel, D., Meyer, M., Harendza, S., 2018. Verbal and non-verbal communication skills including empathy during history taking of undergraduate medical students. BMC Med. Educ. 18, 157.

Amount of information

Avoid information overload  - more information is not always better as patients can forget between 40 – 80% of the medical information that they receive.

Providing the patient with too little information will decrease patient satisfaction

Adherence to advice/ treatment

Adherence is defined as: “the extent to which a person conforms to the the agreed-upon recommendations of a health care provider” WHO. World Health Organisation. Adherence to Long Term Therapies – Evidence for Action. WHO Library Cataloguing-in-Publication Data. 2003.

Factors that may influence patient adherence to treatment include: Alt A, Luomajoki H, Luedtke K. Which aspects facilitate the adherence of patients with low back pain to physiotherapy? A Delphi study. BMC Musculoskeletal Disorders. 2023 Jul 27;24(1):615.

Level of motivation

Self-discipline

Acceptance of specific treatments

Perceived effectiveness of treatment

Beliefs and attitudes

Cultural background

Communicative aspects

Communication skills of healthcare professionals

Motivation to enhance the self-efficacy of patients

Therapist – patient relationship

Professional experience

Resources

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