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What are the primary influences on treatment decisions? How does this reflect on evidence‐based practice? Indications from the discipline of speech and language therapy
Author(s) -
McCurtin Arlene,
Clifford Amanda M.
Publication year - 2015
Publication title -
journal of evaluation in clinical practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.737
H-Index - 73
eISSN - 1365-2753
pISSN - 1356-1294
DOI - 10.1111/jep.12385
Subject(s) - evidence based practice , underpinning , psychology , medical education , evidence based medicine , principal (computer security) , applied psychology , medicine , alternative medicine , civil engineering , pathology , computer science , engineering , operating system
Abstract Rationale, aims and objectives Four pillars of evidence underpin evidence‐based behavioural practice: research evidence, practice evidence, patient evidence and contextual evidence. However, it is unknown which of these pillars or other factors are used by clinicians such as speech and language therapists ( SLTS ) when making treatment choices. The aim of this study was to identify the factors underpinning SLT s' treatment decisions and contextualize findings in terms of evidence‐based practice ( EBP ). Methods Ethical approval was obtained for the electronic questionnaire‐based study. A questionnaire was designed, piloted and then sent via gatekeepers to SLTs to ascertain agreement with a range of statements potentially underpinning treatment choices. Results A total of 249 respondents completed the survey. The respondents defined themselves as dynamic and pragmatic practitioners with an appreciation for the four pillars of EBP . Using factor analysis, treatment decisions were found to rely primarily on practice evidence and pragmatic considerations. Qualifications, clinical experience and the patient group an SLT works with further influenced attitudes and treatment decisions. Those with additional qualifications and experience were identified as more autonomous, more scientific in their treatment choices and less influenced by patient preferences. Conclusion Factors influencing decision making did not clearly align with the four pillars of EBP , the principal influences being practice evidence and pragmatic constraints. The findings of this study have implications for understanding why specific treatment choices are made. Attempts to improve practice should focus on a range of evidence sources and take into account clinician's specific needs depending on career stage, post‐qualification status and patient group factors of their practice.