Levels of evidence

Topic : Describe the influence “levels of evidence” have on practice changes. Identify the most reliable level of evidence and provide an example of the type of practice change that could result from this level of evidence.

American Association of Colleges of Nursing Core Competencies for Professional Nursing Education

This assignment aligns to AACN Core Competency 4.1

Example 1 (Sophia) 

Considering all the avenues in which we can get information from, it does make sense that there is a hierarchy to the validity and its reliability. The most reliable level of evidence is considered to be that of systematic reviews and meta analysis (Ingham-Broomfield, 2016). On the contrary, our textbook suggests that randomized control trials are the highest rated, but nonetheless still included in those levels as well (Helbig, 2022). Systemic reviews seems to be a compilation of scientific research about a particular subject, whereas meta-analysis is considered a step above being that it consists of all randomized controlled trials (Ingham-Broomfield, 2016). Being that meta-analysis consists of these trials, the quantitative studies are combed for their evidence and combined for review (Ingham-Broomfield, 2016). Practice change from this level of evidence is definitely policy change or review (Ingham-Broomfield, 2016). 

On the other hand, the bottom of the pyramid includes opinions, and ideas, it makes sense because even though they can be based on critical thinking from the nurse, a study has not been completed to back up the hypotheses. This makes a difference on practice changes because from here does it stem to seek a higher level of evidence to prove a hypothesis either way. 

Helbig, J. (2022). History and process of nursing research, evidence-based nursing practice, and quantitative and qualitative research process.  In Grand Canyon University (Eds.), Nursing research: Understanding methods for best practice (2nd ed.). Grand Canyon University.

Ingham-Broomfield, R.  (2016). A nurses’ guide to the hierarchy of research designs and evidence. Australian Journal of Advanced Nursing, 33(3), 38–43.

Example 2 ( letha) 

Levels of evidence (sometimes called hierarchy of evidence) are assigned to studies based on the research design, quality of the study, and applicability to patient care. Higher levels of evidence have less risk of bias. 

           Level 1: Evidence from a systematic review or meta-analysis of all relevant RCTs (randomized controlled trials). Level 2: Evidence from at least one well-designed RCT (e.g. large multi-site RCT); Level 3: Evidence from a single well-designed controlled trials without randomization (aka quasi-experimental studies) OR a systematic review of a complete BOE (integrative review of higher and lower evidence) OR mixed methods intervention studies; Level 4: Evidence from well-designed case-control or cohort studies; Level 5: Evidence from systematic reviews of descriptive and qualitative studies (meta-synthesis); Level 6: Evidence from a single descriptive or qualitative study, EBP, EBQI and QI projects; Level 7: Evidence from the opinion of authorities and/or reports of expert committees, reports from committees of experts and narrative and literature reviews (Melnyk & Fineout-Overholt 2023)

A significant part of evidence-based practice is the levels of evidence or hierarchy of evidence in research. Generally, it applies to any type of research and evaluates the strength of scientific results. While there are specific levels of evidence in various disciplines, the most developed is from medicine and allied health.  Evidence is typically ranked based on the methodological quality and reliability of the study design. Systematic reviews and meta-analyses are at the top, followed by randomized control trials, cohort studies, case-control studies, and case reports. The level of evidence in research is a method of raking the relative strength or validity of results coming from scientific studies.

Example: Saunders and his colleagues proposed a protocol that assigns research results and reports into six categories. The assignment is based on the theoretical background, research design, general acceptance, and evidence of possible harm. Much like other levels of hierarchy, it is rooted in allied health. The research outcome should have a descriptive publication such as a manual or something similar.

Category 1: Treatments or results that belong in this category are well-supported and efficacious. Ideally, two or more randomized controlled outcome research compare the study results to the target results. Category 2: Results in this category are supported and possibly efficacious results. It is based on positive outcomes of non-randomized study designs with some control. Category 3: Outcomes in this category are supported and acceptable results. It may be supported by one controlled or uncontrolled study or by a series of single-subject research. Category 4: Promising and acceptable results belong to this category. It may involve studies that have no support, aside from general acceptance and existing literature. Category 5: Innovative and novel results are assigned to this category. It includes studies that are considered not harmful but are not widely discussed or cited in the literature. Category 6: Concerning results belong to this category. It may include outcomes that may possibly do harm and have unknown or untested theoretical foundations (Imed Bouchrika, 2024).

Reference:

Melnyk, & Fineout-Overholt, E. (2023). Evidence-based practice in nursing & healthcare: A guide to best practice (Fifth edition.). Wolters Kluwe. Levels of Evidence – Evidence Based Practice Toolkit – Research Hub at Winona State University. 

 Levels of Evidence in Research: Examples, Hierachies & Practice in 2024. Research.com. .

Example 3 ( vincentia) 

A crucial framework used in the healthcare and medical sectors is the “levels of evidence” framework. It is employed to guide clinical judgment calls and modifications to practice. When practitioners are thinking about novel therapies, interventions, or behaviors, they can use this framework to assess the quality of the evidence. With the use of this framework, which classifies research findings according to their methodology and study design, practitioners can easily assess the trustworthiness and quality of the evidence. Giving Clinical Decision-Making Guidance: There are various levels of evidence that provide a basis for clinical judgements. Evidence at higher levels is usually more reliable and less biased than evidence at lower levels. By doing this, it is ensured that any modifications to practice are based on the most current and relevant scientific research. Resource Allocation”: To make the process of allocating healthcare resources more effectively easier, it is useful to know which interventions are most backed by high-level evidence. A large number of people are more likely to endorse and embrace therapies that have a considerable body of evidence behind them. Many tiers of evidence must be incorporated into the health policy-making process in order to formulate recommendations. These suggestions are responsible for shaping the more expansive frameworks that treatment is provided inside. This could potentially impact national health guidelines, insurance coverage decisions, and other related facets of the problem.

Illustration showing the Greatest Degree of Trustworthiness of All The most dependable level of evidence is determined by systematic reviews and meta-analyses, which are often derived from randomized controlled trials (RCTs). By combining the results of several randomised controlled trials (RCTs), these studies lessen the potential for bias and offer a high level of confidence in the conclusions. This is a possible result because of the careful methodology that each of the randomized controlled trials (RCTs) employed as well as the review process itself. An Illustration of a Material Modification to a Process One example of a change that might be motivated by this degree of evidence in real-world settings is the management of hypertension. This change might serve as an illustration of a therapy plan. A systematic review and meta-analysis could be used to look at numerous randomized controlled trials (RCTs) that compare the effectiveness of different anti hypertensive medications in order to assess each one’s efficacy. Assume for the purposes of this investigation that a novel class of drugs not only effectively lowers blood pressure but also lowers the risk of cardiovascular events in a way that is statistically more significant than the current standard of care. Clinical guidelines may therefore be updated to include this new drug class’s recommendation as the primary treatment for hypertension. This is what would follow from this. This is very likely to result in substantial changes to the prescribing practices throughout the whole healthcare system. There is a significant role that levels of evidence play in the development of medical practice. This is because they ensure that any changes are justified by the most convincing and objective information that is currently available. Because of this, patient care is enhanced, and the outcomes that are accomplished are increased to their full potential.