Meaning and measurement: an inclusive model of evidence in health care

Abstract

Evidence-based approaches are assuming prominence in many health-care fields. The core ideas of evidence-based health care derive from clinical epidemiology and general internal medicine. The concept of evidence has yet to be analysed systematically; what counts as evidence may vary across disciplines. Furthermore, the contribution of the social sciences, particularly qualitative methodology, has received scant attention. This paper outlines a model of evidence that describes four distinct but related types of evidence: qualitative-personal; qualitative-general; quantitative-general and quantitative-personal. The rationale for these distinctions and the implications of these for a theory of evidence are discussed.

On evidence and evidence-based medicine: Lessons from the philosophy of science

“…This preference has prompted critics to detail other sources of evidence that enter into clinical decision-making (Buetow, 2002;Buetow & Keneally, 2000;Upshur, VanDenKerkhof, & Goel, 2001) and to defend the unsystematic intuitions and expertise that arise from clinical experience as epistemically significant and indispensable to clinical decision-making (Tanenbaum, 1993). Yet even before we consider the complex nature of clinical decision-making, we can question the very tenability of the conception of evidence being assumed in evidence-based practice.…”

“…The hierarchy of evidence promotes a certain scientistic accounting of the goals of medicine, which, the worry goes, is incommensurable with the proposed reorientation of medical practice toward the patient's search for meaning in the illness experience. The bridging of scientistic ''measure'' and existential ''meaning'' has received some attention in the critical EBM literature (see, for example, Buetow, 2002;Djulbegovic, Morris, & Lyman, 2000;Upshur et al, 2001) with the general consensus that we need an ''integrated'' model of evidence that properly reflects modern health care's constitution by diverse academic traditions-including the humanities, social sciences, and the pure and applied sciencesthat rely on equally diverse notions of evidence (Upshur et al, 2001, p. 91).…”

Wildlife Health 2.0: Bridging the Knowledge-to-Action Gap

“…• observational, experimental, extrapolated, experiential 7 • experimental, quasi-experimental, survey, administrative, qualitative, economic, ethical/philosophical, systematic review 32 • legal, epidemiologic 22 • quantitative, qualitative 33 • clinical epidemiology, decision science 24 Defined by general purpose:…”

Innovating Medical Knowledge: Understanding Evidence-Based Medicine as a Socio-Medical Phenomenon

“… N of 1 randomized controlled trial  Systematic reviews of randomized controlled trials  Single randomized trial  Systematic review of observational studies addressing patient-important outcomes  Single observational study addressing patient-important outcomes  Physiologic studies (studies addressing blood pressure, cardiac output, exercise capacity, bone density, and so forth)  Unsystematic clinical observations While EBM has evolved over time, most notably in its self-regard from a (polemical) "new paradigm" to a more tempered technique for clinicians to manage vast quantities of research information (for example, Haynes, 2002), the core belief that evidence belongs in fixed hierarchical order with the systematic review of randomized controlled trials always on top remains unshaken (Upshur et al, 2001). In the evaluation of treatment effects, for example, a large, well-designed, randomized trial is considered more reliable than those findings from non-randomized prospective or retrospective studies (Sackett, 1997).…”