JCPSLP Vol 17 Supplement 1 2015_lores

knowledge brokers, policy makers, decision makers, and the community)? 3. When is it appropriate to implement new knowledge with clinical populations? 4. What types of outcomes should be considered during the creation and action cycles of KT? 5. What mechanisms can be used to align KT processes with ethically sound practice? When reflecting upon these questions, one must be mindful that ethically sound KT is underpinned by three key features (Graham & Tetroe, 2007). First, KT is grounded in the ethical principles of beneficence (to do good) and non-maleficence (to avoid harm). In keeping with these principles, KT aims to develop safe and efficacious interventions that avoid harm and provide significant benefits to clients. These aims depend upon researchers to provide valid and reliable evidence before findings are disseminated to practitioners. These aims also depend upon clinicians eschewing non-evidence-based practices that may be marketed to vulnerable clients through unregulated internet sources (Meredith, Firmin & McAllister, 2013). Moreover, clinicians must respond to the community expectations regarding access to knowledge in a format that is appropriate for their needs (O’Halloran & Rose, 2010). Second, KT interventions must meet ethical standards and comply with the legal and regulatory frameworks of the profession. The second feature acknowledges the role of the Professional Association and Board of Ethics in clearly articulating professional values that govern the application of knowledge. The third feature of KT is that the social and economic consequences of an intervention must be carefully considered since sustainability of health care programs may be impacted by budgetary constraints. This feature addresses the complex interplay between evidence and economics and the aims for KT to guide judicious use of health care resources. In other words, the “how, when and with whom”, new knowledge is adopted in health care settings. These vexing issues have been addressed with ethical analysis. Trevor-Deutsch, Allen and Ravitsky (2009) proposed a bioethical framework for KT based upon dual perspectives of utility and justice. Utilitarian perspectives dictate that decisions should be based upon achieving the greatest benefit for the greatest number of people (Freegard, 2006). Hence, any new practice or innovation should attempt to maximise benefits while taking commensurate steps to minimise risks. Further, resource allocation decisions should be based upon potential benefit to individuals and society. Evaluation of benefits and risks is multidimensional and needs to incorporate holistic and long-term vision. For example, a decision to provide an adult client with dysphagia treatment but limited or no communication intervention may initially appear ethically sound when a speech pathologist cannot meet caseload demands. However, such a decision fails to take into account the potential impacts of aphasia and the importance of rehabilitation during the early stages of recovery (Grohn, Worrall, Simmons-Mackie & Brown, 2012). A justice perspective determines that benefits resulting from KT should be fairly distributed among individuals, and within and among communities (Berglund, 2007). Here, justice is not simply interpreted as “each receives the same” but incorporates a concept of “each according to need” (Edwards, 1996). Just and fair resource allocation is not

an easy process – decisions regarding need and priority can be a source of great anxiety when they need to be balanced with equity and prognosis (Kenny, Lincoln, Blyth & Balandin, 2009). Furthermore, clinicians must be vigilant against gradually “watering down” best practice in response to resource constraints. In accordance with utilitarian and justice principles, Lafrenière, Hurliman, Menuz and Godard (2013) reviewed the available KT literature and developed guiding questions for incorporating ethics into each step of the Knowledge to Action Process Framework (Graham et al., 2006). The summary presented in the following section, was drawn from their list of guiding questions. Ethics applied to the Knowledge to Action Framework During stages of knowledge creation , participants must make an informed and autonomous choice regarding their involvement in the research. Participants’ privacy and the confidentiality of their personal information must be protected and strategies must be in place to avoid harming participants during research processes or in the presentation of findings (Smith, 2003). There must also be appropriate rationales for excluding individuals or groups from research opportunities because exclusion may result in some members of the community having no voice during the knowledge creation process (Leitão et al., 2012). Identification of research problems must be based upon health care priorities. The needs and motivations of stakeholders need to be articulated and decision-making processes made transparent. The human, financial, temporal, and material resources invested in a research problem are expected to provide knowledge that will benefit individuals and society and such investments must be directed towards research that may have relatively greater benefits for a profession and community. To ensure this outcome, it is imperative that clinicians either communicate with researchers so that real clinical issues are pursued, or that clinicians undertake research in their clinical practice. Indeed, we need to close the gap between clinicians and researchers so that clinicians can direct research according to clinical need and researchers translate their findings into clinically useful strategies (Davies, Robertson, Stevens & Thomas, 2006). The Clinical Centre for Research Excellence in Australia, for example, has engaged in a comprehensive process of community engagement and developed strategies for translating aphasia research into innovative practice (Power & Worrall, 2011). Knowledge must be adapted to the culture and worldview of consumers so that they may benefit from new approaches. Lafrenière et al. (2013) argued, for example, that the limited effectiveness of some public health programs in indigenous communities may be due to externally imposed strategies that ignore local understandings of health and illness and cultural mechanisms for sharing knowledge. Factors that may result in misapplication of knowledge and misuse of resources must be identified and addressed to avoid harming communities or individuals. Again, a close relationship between researchers, clinicians and the community may enhance the likelihood that knowledge will not be applied inappropriately and the best evidence will reach targeted communities (Kagan, Simmons-Mackie, Brenneman, Conklin & Elman, 2010).

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JCPSLP Volume 17, Supplement 1, 2015 – Ethical practice in speech pathology

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