The Handbook for Evidence-Based Practice in Communication Disorders - Softcover

Dollaghan, Christine A.

Softcover

ISBN 10: 1557668701 ISBN 13: 9781557668707

Verlag: BROOKES PUB, 2007

Inhaltsangabe

With this landmark textbook, speech-language pathologists will learn to apply current best evidence as they make critical decisions about the care of each individual they serve. The first text that covers this cutting-edge topic for the communication disorders field, this book introduces SLPs to the principles and process of evidence-based practice, thoroughly covering its three primary components: "external" evidence from systematic research, "internal" evidence from clinical practice, and evidence concerning patient preferences. SLPs will get the in-depth guidance they need to

• construct the right questions about best evidence



• find the reliable information they need to answer these questions



• evaluate the validity of both internal and external evidence



• weigh the importance of empirical evidence, whether from a research study or from an individual patient



• help patients fully understand clinical options and express their preferences



• conduct systematic, critical appraisals of treatment evidence, diagnosis and screening evidence, and evidence from systematic reviews or meta-analyses

Developed by Christine A. Dollaghan, one of the most highly respected researchers in the field of language acquisition and disorders, this text makes complex concepts understandable with its clear, reader-friendly language, vivid step-by-step examples of key processes, and illuminating figures and tables.

SLPs will come away with a solid, practical understanding of evidence-based practice—knowledge they'll use throughout their careers to make sound clinical decisions about the screening, diagnosis, and treatment of communication disorders.

Über diesen Titel

Über die Autorinnen und Autoren

Christine Dollaghan, Ph.D, Professor, Callier Center for Communication Disorders, University of Texas at Dallas, 1966 Inwood Road, A.128, Dallas, TX 75235
Christine Dollaghan is a professor at the University of Texas at Dallas. Her research interests include child language development and disorders, the validity of diagnostic measures, and the latent structure of diagnostic categories. Her publications include The Handbook of Evidence-Based Practice in Communication Disorders (Paul H. Brookes Publishing Co., 2007). She was awarded the Honors of the American Speech-Language-Hearing Association in 2012.

Christine Dollaghan, Ph.D, Professor, Callier Center for Communication Disorders, University of Texas at Dallas, 1966 Inwood Road, A.128, Dallas, TX 75235
Christine Dollaghan is a professor at the University of Texas at Dallas. Her research interests include child language development and disorders, the validity of diagnostic measures, and the latent structure of diagnostic categories. Her publications include The Handbook of Evidence-Based Practice in Communication Disorders (Paul H. Brookes Publishing Co., 2007). She was awarded the Honors of the American Speech-Language-Hearing Association in 2012.

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Excerpted from Chapter 1 of The Handbook for COMMUNICATION EVIDENCE–BASED PRACTICE in DISORDERS, by CHRISTINE A. DOLLAGHAN, PH.D., CCC–SLP

Copyright © 2007 by Paul H. Brookes Publishing Co. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.

EVIDENCE–BASED PRACTICE: AN EXPANDED DEFINITION

It sometimes seems as though evidence–based practice (EBP) is taking over the world. EBP is a key topic of discussion (and controversy) in fields as diverse as clinical laboratory science (e.g., McQueen, 2001), nursing (e.g., Rutledge, 2005), physical medicine and rehabilitation (e.g., Cicerone, 2005), occupational therapy (e.g., Tse, Lloyd, Penman, King, & Bassett, 2004), psychology (e.g., Wampold, Lichtenberg, & Waehler, 2005), psychiatry (e.g., Hamilton, 2005), and education (e.g., Odom, Brantlinger, Gersten, Horner, Thompson, & Harris, 2005). Sessions on EBP began appearing on the program of the annual convention of the American Speech–Language–Hearing Association (ASHA) in 1999, and the move toward EBP has been endorsed in an ASHA technical report (ASHA, 2004) and position statement (ASHA, 2005a). An evidence–based orientation can even be found in a book about the success that resulted for a baseball team when prospective players were evaluated with objective performance measures in addition to the subjective impressions of baseball scouts (Lewis, 2003).

Its rapid spread notwithstanding, EBP has generated negative as well as positive reactions. Most criticisms can be traced to several problems with the way that the phrase has come to be understood. One problem is that the EBP "movement" seems to imply that until EBP came along, practitioners were basing their clinical decisions on something other than evidence, which is simply not true. In addition, most people seem to think that EBP involves only research evidence, which also is not true. Sackett, Rosenberg, Gray, Haynes, and Richardson (1996) originally defined evidence–based medicine as "… the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients … [by] integrating individual clinical expertise with the best available external clinical evidence from systematic research" (p. 71). Both research evidence and clinical expertise were a part of this original definition, and a third component (the patient's perspective) was added to the subsequent definition of EBP as ". . . the integration of best research evidence with clinical expertise and patient values" (Sackett, Straus, Richardson, Rosenberg, & Haynes, 2000, p. 1). Despite the inclusion of clinical expertise and patient values in definitions of EBP, it is clear that the emphasis on scientific evidence has overshadowed the other two components.

As a way of bringing all three components into focus, I'd like to suggest that we think of EBP as requiring not one but three kinds of evidence, and the abbreviation E3BP will be used to help keep all three types of evidence in mind. Accordingly, the definitions discussed previously will be adapted (Sackett et al., 1996, 2000), and in this handbook we will define E3BP as the conscientious, explicit, and judicious integration of 1) best available external evidence from systematic research, 2) best available evidence internal to clinical practice, and 3) best available evidence concerning the preferences of a fully informed patient.

This definition will allow us to circumvent several criticisms and confusions that have bedeviled the previous concept of evidence–based practice and its progenitor, evidence–based medicine (e.g., Cohen, Stavri, & Hersch, 2004; Rees, 2000). For one thing, the definition of E3BP clearly distinguishes between external and internal sources of strong evidence and highlights the importance of both for clinical decision making. Evidence internal to clinical practice with a particular patient is an important complement to external evidence from systematic research because although high–quality external evidence can reveal valuable information about average patterns of performance across groups of patients, its applicability to an individual patient is unknown (Bohart, 2005). Conversely, high–quality internal evidence from clinical practice with an individual patient is surely relevant to making decisions about that patient (Guyatt et al., 2000), although its applicability to other patients or groups of patients is likewise unknown.

Those who work in behavioral sciences, and especially in communication sciences and disorders, have an advantage when it comes to obtaining strong internal evidence because of experience with well–developed single–subject methodologies (e.g., Horner, Carr, Halle, McGee, Odom, & Wolery, 2005) for measuring change in individual patients. Although the need for such methods is clear, Sackett et al. (2000) acknowledged that the use of such methods in medicine is in its infancy. The expanded definition emphasizes that strong evidence internal to clinical practice can and must be incorporated to make E3BP a reality in communication disorders.

Finally, E3BP also requires strong evidence about our patients' beliefs, preferences, hopes, and fears (e.g., McMurtry & Bultz, 2005) concerning the clinical options that face them. To paraphrase Sullivan (2003, p. 1595), "facts known only by practitioners need to be supplemented by values known only by patients." Incorporating this third type of evidence requires that we develop a shared understanding of our clients' perspectives, as well as ensuring that clients comprehend their clinical alternatives so that they can express meaningful preferences.

You may have noticed that the expanded definition of E3BP does not refer specifically to clinical expertise, which was a key component of the original definitions by Sackett et al. (1996, 2000). That is because in my view clinical expertise is not a separate piece of the E3BP puzzle but rather the glue by which the best available evidence of all three kinds is integrated in providing optimal clinical care.

PRECONDITIONS TO E3BP

According to this expanded definition, successful E3BP has three preconditions:

1. Uncertainty about whether a clinical action is optimal for a client
   
   
2. Professional integrity (comprising honesty, respectfulness, awareness of one's biases, and openness to the need to change one's mind)
   
   
3. Application of four principles that underpin clinical ethical reasoning: beneficence (maximizing benefit), nonmaleficence (minimizing harm), autonomy (self–determination), and justice (fairness)

Thus, E3BP requires honest doubt about a clinical issue, awareness of one's own biases, a respect for other positions, a willingness to let strong evidence alter what is already known, and constant mindfulness of ethical responsibilities to patients (e.g., Kaldjian, Weir, & Duffy, 2005; Miller, Rosenstein, & DeRenzo, 1998).

The crucial role of uncertainty in E3BP is worth emphasizing. Seeking evidence not in an effort to reduce honest uncertainty but rather in an effort to prove what one already believes is contrary to the fundamental thrust of E3BP. It is also likely to be a waste of time, because any contradictory evidence will be ignored or discounted in favor of evidence that supports one's point of view.

Awareness of the powerful and distorting effects of subjective bias has been a major impetus for the evidence–based orientation. All people have biases or preconceived notions that frame, organize, and often simplify their perception of the world. Francis Bacon was one of the first to address the ways in which biases can weaken the ability to...

Details zur Ausgabe

• Verlag: BROOKES PUB
• Erscheinungsdatum: 2007
• Sprache: Englisch
• ISBN 10: 1557668701
• ISBN 13: 9781557668707
• Einband: Taschenbuch
• Auflage: 1
• Anzahl der Seiten: 169
• Kontakt zum Hersteller: Nicht verfügbar
• Verantwortliche Person: Nicht verfügbar