Gathering and Evaluating Evidence in Clinical Decision-Making La collecte et l’évaluation de données probantes pour la prise de décision clinique

This paper presents evidence-based clinical decision-making as a process of anticipating therapeutic benefit on the basis of thorough consideration of evidence from a variety of sources. In this process, evidence encompasses the values, beliefs, and experiences of both the client and the clinician, as well as knowledge accrued from all varieties of scientific research. In particular, we suggest structuring the gathering of evidence in terms of Peirce’s (1877) classification of sources of evidence. In contrast to expert opinion in evidence-based medicine, we do not advocate the use of a hierarchy in which randomized clinical trials are accepted universally as the most worthy type of evidence. Instead, we suggest evaluating the degree to which the elements of a study fit together to serve a common purpose. Doing so will strengthen clinical practice by providing it with a broader and more dynamic evidence base.