Evidence-based medicine (EBM) and clinical ethics: toward Shared Decision-Making (SDM)

Abstract

Evidence-based medicine (EBM) is "decision-making for better patient care that integrates current evidence, clinical expertise, patients' preferences and values and circumstances". It is important to be aware of the distinction between evidence as research findings and EBM, which is comprehensive decision-making that takes into account the diversity and individuality of clinical situations while respecting evidence as a general theory. Clinical practice guidelines are "a document that evaluates the total body of evidence through a systematic review and presents recommendations that are considered optimal, taking into account the balance of benefits and harms, in order to support decision making by healthcare users and providers on important health-related issues," and is useful in the practice of EBM. Shared decision-making (SDM), which has been attracting attention in recent years, is "a process in which the patient and the health care provider, through dialogue, decide on a treatment plan that is acceptable to the patient, based on the patient's own preferences and values, research evidence, and the clinical expertise" and requires understanding in relation to the above definition of EBM with perspective of clinical ethics.