With the enormous amount of published literature, it is practically impossible for individual clinicians to routinely use the 5 steps of evidence-based practice to frame their research question, search for and find a suitable research article, and appraise the research quality and context to apply the findings to their own patient. Clinical guidelines have been developed, mostly by independent and expert groups, to integrate the best available research evidence, to guide decision making for many clinical conditions.
At best, clinical guidelines use systematic reviews which have summarised and synthesised all relevant research papers around a single clinical question. This way, they represent the current shared knowledge about what works best, for certain patients. They can be developed through a rigorous and consultative process where clinician experts contribute their practical experience through the process of critical appraisal. When there are clear summaries of the research evidence, clinicians can make better decisions, individualising care for their patients.
At worst, clinical guidelines do not discriminate between research of varying quality and they can be subject to all the potential biases and errors made while conducting research. Research findings can be given equal importance in decision making despite the underlying projects having different risks of bias. There many not be enough information about which patients are most or least likely to benefit. Often, it is difficult to go back to the underlying research, to check which patients were included and in what context it was carried out. We know that patients who participate in clinical trials are different from the population they come from. Many times, the adverse events are not accurately reported. At other times, expert opinions are included without being identified in this way. Finally, one of the biggest challenges to current practice is the way guidelines are being used as standards of practice and potentially curtailing clinicians’ abilities to use their clinical judgement in an informed way.