The transition from inquiry to evidence to actionable clinical knowledge: A proposed roadmap

Rationale, aims, and objectives We consider the question "What should we do?" in the context of clinical research/practice. There are several steps along the way to providing a satisfactory answer, many of which have received considerable attention in the literature. We aim to provide a unified summary and explication of these "steps along the way". The result will be an increased appreciation for the meaning and structure of "actionable clinical knowledge". Methods We review the literature to identify pertinent works dealing with evidence production and translation into actionable clinical knowledge. We draw from insights in this literature about various aspects of reasoning relevant to clinical questions and integrate these into a unified approach to the processes that lead to actionable clinical knowledge. Results We collect, collate, and integrate some of the work by Bauer, Carper, Goldman, Haack, McHugh and Walker, and Upshur and colleagues and obtain guidelines to aid in the evidence-to-actionable-clinical- knowledge transition. Conclusions Clinical decision-making is not infallible, and the steps we can take to minimize error are context dependent. Medical evidence, produced as it is by human effort, can never be perfect. We will be doing well by assuring that the evidence we use has been produced by a reliable process and is relevant to the question posed.