Evidence-based medicine beyond the bedside: Keeping an eye on context

Rationale: Evidence-based medicine is being applied to decisions in a range of contexts beyond one-to-one patient care. Yet considerable disagreement persists regarding the defining components of evidence-based decision-making, particularly in institutional and public health contexts. Aims and Objectives: This article reviews the key elements of evidence-based decision-making for clinical medicine, and adapts those key elements and argues for their broad applicability to a variety of decision-making contexts including institutional, public health, and self-care decision-making contexts. Methods: Conceptual Analysis. Results: Evidence based decision-making involves research evidence, "social and institutional circumstances", and "values" of stakeholders. Furthermore, evidence-based decision-making includes "judgment" exercised by experts to appropriately weigh and integrate the various decision-making elements. Conclusion: Asking critical questions about the purposes and context of a specific decision, basic principles of evidence-based reasoning can be appropriately applied beyond the bedside.