Dunja Dreesens

132 Use the best of both worlds Another overarching issue is that the different approaches in health care share elements. To achieve quality health care or optimal care, patient engagement is essential. Both evidence- based medicine (EBM) and shared decision-making heralded from their beginnings the formal recognition of patient engagement (26, 166, 168). Both struggle with getting evidence and patient preferences into daily practice of health care (68, 308, 309). Despite the partially equal footing and aim, EBM and SDM have been separate worlds for a long time (310-312). At the same time, because of the partially equal footing and aim, it has been argued that EBM and SDM should be brought closer together. Barratt, even though not agreeing on patient engagement as being part of EBM, made suggestions how research evidence as well as patient preferences could be combined and put into practice better. Next to funding trials that answer patients’ questions better, and including patients in working groups and committees in health care, she suggested to develop tools that provide healthcare professionals and patients with answers to evidence-based questions and help them elicit and integrate patient preferences. Barratt however did not combine the tools yet, distinguishing between tool types for answering evidence based questions and other tool types to find out about patient preferences and to integrate them into the decision-making (310). However, more voices to connect and combine the approaches and their tools were speaking up. Van der Weijden et al proposed strategies to adapt clinical practice guideline – the epitome of EBM – to facilitate shared decision-making (249). Acknowledging that EBM and SDM have different origins – SDM emerging from law practice (313) and communication for example, and EBM from clinical epidemiology – Hoffmann et al propose to connect the two approaches as well, claiming that ‘authentic EBM’ as they call it, cannot occur without SDM (see figure 1). A strategy they suggested is to bring SDM and EBM together in clinical practice guideline development and implementation, as most CPGs still do not consider patient preferences and/or do not offer how to discuss these preferences, and talk about evidence in such a way that a patient understands it. The teaching of clinicians and students needs to be addressed as well as it focusses on critical appraisal and clinicians are not taught in depth how to integrate and apply evidence in daily practice when dealing with individual patients. They recommended combining EBM training with SDM and communications skill training (311). Chapter 7 Figure 1: The interdependence of EBM and SDM, and ‘their’ tools (adapted from Hoffmann et al, 2014)