JCPSLP Vol 14 No 1 2012

Professional issues

What’s the evidence for translating EBP into clinical practice? Jade Cartwright

T his column of “What’s the evidence?” follows on from the “Ethical conversations” in this issue of the Journal of Clinical Practice in Speech-Language Pathology around the ethical and professional issues currently facing clinicians in the workplace. Evidence based practice (EBP) was a recurring theme throughout the discussion with members of the Ethics Board acknowledging the increasing trend for both clinicians and consumers to endorse evidence based perspectives. A critical point to emerge related to “how research findings are actually interpreted and applied in the professional community” (Leitão et al., this issue, pg 33) to ensure that the translation of evidence to practice is appropriate and doesn’t restrict access, choice, or outcomes for individual clients. This caution is counterintuitive as through EBP clinicians strive for “optimal practice”. However, it is not always clear how effectively research actually does (and can) inform professional practice at the coalface, where administrative and system-level factors can significantly impede or restrict this translation. In fact the “prevailing disconnect between what we know to be effective and what we practice daily” (Liang, 2007, p. w120) is widely reported in the health sciences literature and many attempts to translate evidence into clinical practice are unsuccessful or only partially successful (Lizarondo, Grimmers-Somers, & Kumar, 2011; Sales, Smith, Curran, & Kochevar, 2006; Small, 2005; Sudsawad, 2007). Interestingly, a recent survey of 123 speech pathologists working for Ageing Disability and Home Care (ADHC) in New South Wales revealed that 61.4% of speech pathologists surveyed either agreed or strongly agreed that there was a definite divide between the findings of research and application in clinical practice (Togher, Trembath, & Brunac, 2011). Yet the vast majority either agreed or strongly agreed that the application of EBP is a necessary part of speech pathology practice (89.5%) and guides decisions about client care (90.3%) (Togher et al., 2011). This finding suggests that a specific skill-set is perhaps required above and beyond EBP itself to ensure successful implementation and service change in light of strong evidence and practice guidelines. This “What’s the evidence?” column reviews the current evidence for “evidence translation” to offer clinicians some ideas for demonstrating and proactively addressing evidence– practice gaps. Clinical scenario Imagine you are a clinician working in a busy teaching hospital. As a senior speech pathologist you are responsible for covering the Neurology Ward and Stroke

Unit. Your caseload is busy and complex with a strong push for early discharge and reduced length of stay. Over the past two years you have read extensively and attended a number of continuing professional events in the areas of aphasia and dysphagia rehabilitation and best practice; however, you have not been able to implement much of your new knowledge. As is typically the case in this setting the assessment and management of dysphagia takes the priority and most of your day is spent conducting bedside swallowing examinations, while also fitting in regular team and family meetings into your busy schedule. It is extremely hard to find time to plan and complete new projects and one of your greatest bugbears is the paucity of time you have available to address your clients’ communication needs. You constantly reflect on how best practice could be achieved within the constraints of the system and how you can get your strong knowledge about the current evidence into practice. It is not a question of what the evidence says or what you should be doing as you are well aware of the research around the efficacy and effectiveness of aphasia treatments; it concerns more the actual translation of this evidence into practice. In other words: how can service change be successfully implemented (and sustained) to meet the recommended clinical guidelines and bridge the divide between evidence and practice to enable optimal client outcomes? Response to this scenario The clinical scenario is common across health areas and one that may contribute to despondency and reduced job satisfaction. I know that I have experienced frustration myself many times in practice when you know the current best evidence and expert opinion in the field but your ability to translate this evidence is compromised by external pressures on the service, such as caseload size and complexity, availability of managerial support and/or resources, and engrained service delivery models. Much of the EBP literature in the speech pathology arena has focused on critical appraisal of the research evidence as opposed to the implementation of the ‘clinical bottom line’ or best practice recommendation to emerge. When a clinician has the knowledge but doesn’t translate this knowledge into routine practice it is called a “knowledge-to- action” (KTA) gap (Molfenter, Ammoury, Yeates, & Steele, 2009) and this is the point where energy must be directed to bridge the knowledge–practice divide. Research supports the notion that transferring knowledge into action is a time consuming process (Molfenter et al., 2009). As a

Jade Cartwright

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JCPSLP Volume 14, Number 1 2012

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