JCPSLP Vol 23 Issue 2 2021

Implementation science

Ethical conversations Suze Leitão, Grant Meredith, Dave Parsons

S ection 3.1 in the 2020 Speech Pathology Australia Code of Ethics (2020a), reminds us that: We ensure our professional practice is underpinned by the best available and generally accepted evidence. We consider evidence from systematic research as well as the best available evidence from clinical practice and the preferences of a fully informed client. We understand and act according to the strengths and limitations of the best available evidence to ensure beneficence and non- maleficence. So how do speech pathologists access this knowledge and evidence? How do we implement it in our clinical work to ensure beneficence and non-maleficence in our daily practice? In this Ethical conversations column, we—Suze Leitão and Grant Meredith—chatted with Dave Parsons, an occupational therapy clinician and academic from Curtin University, about all things “knowledge translation and implementation science”. As long-term members of the SPA Ethics Board, we [Suze and Grant]were especially interested in exploring ethical obligations that arise for both research “producers” and research “consumers” (aka clinicians and our clients) with Dave. Dave is passionate about knowledge translation, research capacity building in the allied health professions and consumer engagement in research, and we really enjoyed our chat with him. We hope you enjoy reading our “conversation”! We began by asking Dave to give us a simple summary of what exactly “implementation science and knowledge translation” is. Knowledge translation and implementation science are similar but slightly different. In simple terms, both concepts are primarily focused on the theories, measurement and dissemination strategies of research, specifically, evidence- based practice, to improve the quality of clinical practice (Grimshaw et al., 2012). Knowledge translation refers to development of strategies and processes to implement new knowledge we obtain from doing research into clinical practice or policy. In contrast, implementation science is more focused on the systematic and scientific enquiry about how knowledge is translated. In other words, implementation science is the academic discipline of researching how knowledge is translated into practice (Bauer et al., 2015).

So, how important is knowledge translation then for contemporary speech pathology clinical practice, and relatedly, for evidence- based practice? Knowledge translation is so important on so many levels for speech pathology clinical practice. As clinicians, we have a fiduciary obligation (a greater ethical responsibility to our clients than they do to us, given our professional knowledge and position of power) to our clients to ensure the interventions we are providing are supported by strong empirical evidence. This is so important, as, if we do not provide proven effective interventions, then we are wasting precious resources, and failing to achieve the balance between beneficence and non-maleficence. Very much linking to the values and principles within the Code of Ethics. Yes, but, the issue is not only one of resource waste. There is also the “opportunity cost” of using ineffective interventions that must be considered. If a client is using their finite resources—whether that be time, emotional, physical or financial—on an intervention that is not evidence-based, then those resources cannot be spent on interventions that are supported by research. For children, we all know the importance of early intervention. This period of time in a child’s life is absolutely precious, and if these resources are used to implement ineffective or unproven interventions for our clients, then we are essentially wasting this critical window in our client’s development. Ultimately, this presents a critical ethical argument for the need for health professionals to take it upon themselves to seek out and use the best available evidence-based interventions, as well as for researchers to make this information easily accessible, digestible and implementable for clinicians. What barriers do you think are hampering the uptake of evidence-based practice into regular practice? This is a really great question. In my opinion, I think there are a number of barriers that exist in the translation of research into clinical practice or policy. One of the key drivers up until recently is the differences between researchers and clinicians in their definition of success. For researchers working in the higher education environment or a research institute, “success” has historically been defined by research metrics—namely, journal articles published, grants obtained, and the number of higher degree by research students they have supervised

From top to bottom: Suze Leitão, Grant Meredith, Dave Parsons

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JCPSLP Volume 23, Number 2 2021

www.speechpathologyaustralia.org.au