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What is Evidence?

by Kelsey White, MDiv, MSc, BCC, Transforming Chaplaincy Fellow, PhD Student University of Louisville
with Ronald Oliver, PhD, MBA, BCC,APC President

APC Forum, October 2019, Vol. 20 No. 6


The popularity of the word “evidence” these days sometimes makes it feel like it deserves its own hashtag. Any claim could be backed by evidence, but not every claim is backed by valid evidence.
For professional chaplains, scientific inquiry increasingly dominates how we and our colleagues use “evidence.” Clinicians strive to have as much evidence as possible to guide decisions and the provision of care. But what exactly does “evidence” mean?  In its simplest form, evidence is proof that backs up a claim.
What, then, counts as proof? Or, how much research does one need to have evidence? Typically, having proof or evidence means using the scientific method to explain a how close a relationship comes to one that is both generalizable and causal. Getting one’s evidence to the “generalizable” and “causal” point is easier said than done. Researchers often refer to the pyramid heuristic called the “evidence hierarchy” (or the “evidence).”

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At the top of the pyramid is the most generalizable (and causal) evidence and at the bottom of the pyramid the evidence is simply descriptive in nature.   Researchers aim to get as close to the experimental apex as possible with as rigorous study design as possible.  How the study is planned determines how close the evidence will come to the top of the pyramid. How close the study gets to the top, the more generalizable and causal the results could be. In contrast, research conducted with descriptive or qualitative methodology (expert opinion, interviews, case studies, etc.) typically aim to look in depth at a subject.  This qualitative method, while important, limits wider applicability.
To illustrate, a detailed observation and interview with my three-year-old in his playroom would highlight his love of cars as well as his preference for backseat driving. Even after a thorough analysis of this particular phenomena and even if I asked the opinion of a few moms with three-year-olds,  I could in no way claim I have evidence that all three-year-olds who play with cars tell their mothers how to drive. If I took a random sample of 1,000 three year-olds, exposed some to toy cars and did not expose others, and noticed that only the children who played with cars gave their mothers driving directions, could I then potentially say I had the evidence to claim that playing with toy cars causes children to become backseat drivers. Even with a perfect experimental design, having rigorous evidence also requires the correct statistical techniques.
APC’s competencies are “evidenced-based.”  Our certification is “evidence-based.”  Admittedly, to date, our evidence has relied on the opinion of experts.  Even so, this is reliable evidence and no other spiritual care organization has evidence for their certification beyond expert opinion.  APC and NACC are supporting empirical research that has the goal of strengthening our certification process.  Stay tuned.
While utilizing conclusions, processes, and guidelines that are “evidence based” is always preferable, the informed professional will always ask the discerning question: “What kind of evidence supports the claim?