After formulating focused clinical questions and locating the best available evidence, we need to engage in the steps of critically appraising the trustworthiness of the evidence and assessing the relevance of the evidence to the context described in our focused clinical question. After determining that the evidence is both trustworthy and relevant to our clinical question, we need to summarize the key findings of the evidence in a way that is easily accessible to our health care team and determine how to implement those findings in the clinical setting. The final step in the EBP process is reflecting on the results of your implementation and learning from the experience.

Evaluating Sources for Trustworthiness

When we are using sources to guide our decision-making in healthcare, it is important that we are using the highest quality, most reliable evidence available. While there are some instances in life where acting on the advice of questionable recommendations isn’t disastrous, when we are dealing with healthcare decisions, the actions we take could literally be life or death. We need resources that are trustworthy. But, what does it mean to be trustworthy? According to the Oxford English Dictionary, something that is trustworthy is “able to be relied on as honest or truthful.” Let’s take a look at the idea of trustworthiness in the context of health information and the digital age.

According to a study by the Pew Research Center (2013), nearly 60% of people start their searches for health related information by Googling! However, there is no guarantee that the information people find on the internet is true or reliable. So, we need a quick and easy way to determine if the sources we are looking at are trustworthy. Two methods are commonly recognized (Protillo, Johnson & Johnson, 2021) as effective strategies for determining if health information is trustworthy – DISCERN and The CRAAP Test.

DISCERN

DISCERN is an online questionnaire that helps people assess the quality of health information related to medical treatment options.  The questionnaire can be accessed at http://www.discern.org.uk/discern_instrument.php . Researchers Charnock and Shepperd (2004) spearheaded The DISCERN project and performed the research underpinning the development of the questionnaire. They designed the questionnaire to support evidence-based practice and it has been validated by numerous independent studies.

The DISCERN questionnaire consists of 16 questions. You will note that some questions are particularly focused on treatment options, making this method of discerning reliability less helpful for evaluating publications focused on diagnoses, diagnostic testing, or disease-specific information such as etiology and prognosis. The questions included in the DISCERN questionnaire are presented below.

The CRAAP Test

The CRAAP Test method of evaluating information sources was first developed by Sarah Blakeslee (2004), a university librarian who wanted a memorable way for students to remember the criteria for evaluating the reliability of published information. She notes, “For every source of information we now have a handy frame of reference to inquire, ‘Is this CRAAP?'”

The CRAAP Test consists of 5 criteria – Currency, Relevance, Authority, Accuracy, and Purpose. Details for performing the CRAAP Test are outlined below.

Summarizing the Evidence

When writing for evidence-based practice we want to use an approach that is similar to the guidelines and synthesized summaries we discussed in our examination of levels of evidence in chapter four. We want to focus on identifying the important features and concepts gleaned from the resource and how those features and concepts can be applied in the clinical setting. This is different from writing essays or reports. We want to use headings, tables, bulleted or numbered lists, and other formatting options to make the relevant information easy to locate for the members of our health care team. We can include images as long as we explain the important features of the image and how it relates to our focused clinical question.

Determine your Focus

When you summarize publications for evidence-based practice, you want to keep your focused clinical question at the forefront of your mind. The purpose of your summary is to answer your focused clinical question. So, your summary should focus on how the publication relates specifically to your clinical question. If it isn’t related to your clinical question, don’t include it. Don’t lose sight of the big picture – answering your question.

Reading the Article

Before you can summarize the evidence, you have to understand it. This can frequently take longer than you anticipate. Only when you understand the information well enough to explain it to someone else are you ready to write your summary.

Start by scanning the article. Pay close attention to the research question and reason for the study to identify the aims (usually found in the introduction in research articles).  Then skip to the findings (results section) and how those findings were interpreted (in the discussion or conclusion). Underline or highlight key sentences or write the key point of each paragraph in these sections. While you may be able to discover some key points in the abstract, you will need the details found in the introduction, results, and discussion sections to clearly explain what you found.

After you have recorded the main points, ask yourself the following questions:

• What are the questions being answered?
• How does the study address the research questions?
• How convincing are the results? Did you find anything surprising?
• How does this publication contribute to your focused clinical question?
• What aspects of your focused clinical question remain unanswered?

Put it in your own words!

Putting things in your own words helps you avoid plagiarism. We are also wanting to avoid direct quotes in these summaries. The original authors are carefully explaining the entire process. We want a quick and dirty understanding of how their work helps answer our question. If you cannot put it in your own words, you probably don’t understand it well enough and should re-read the publication.

Writing the Summary

The purpose of a good summary is to give your reader an overview of the important concepts in the publication as they relate to the clinical question being asked. To do this, you must decide what is important and condense that information for your reader.

Level of Evidence Support

Like the guidelines and synthesized summaries we discussed earlier, we want to start our discussion of our findings by letting our reader know what level of evidence supports the findings we are summarizing.  The findings from Filtered information (guidelines and synthesized summaries) are most widely applicable of all the resources and are the most reliable. The findings from Unfiltered information (original research studies) are limited by the populations they seek to describe and the sample sized employed in in the study, but have research evidence support. The findings presented in Background information sources is generally accepted as true, but may or may not have research evidence to support them. An example of informing your reader of the level of support for the findings could look something like this:

The publication by Blakesee (2004) is a background information source.

Writing the Summary

References