Essence of evidence-based medicine: A case report

Purpose: To illustrate the complexities of the evidence-based approach in c linical oncology practice and the implications for guidelines and evaluatio n of processes of core. Patient and Methods: A case report is presented in which a limited systemat ic review of the literature was used to address a specific clinical problem in an individual patient. Experts' opinions were also sought. Results: A reasonable clinical decision was made by a participating patient based on indirect evidence of benefit that would be insufficient to suppor t the same decision as a health policy in some jurisdictions. Conclusion: The practice of evidence-based oncology requires clinical judgm ent about the validity and applicability of research evidence. The factors that influence an evidence based decision in the clinical context differ fr om those in the broader policy context, which could lead to legitimate diff erences in recommendations based on the same information. Used properly, th e individual case report can be a powerful tool to illustrate complex clini cal decision phenomena. (C) 1999 by American Society of Clinical Oncology.