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EBPP Clinicians (Benefits (Foster attitude of life-long learning and skill…
EBPP Clinicians
Benefits
Foster attitude of life-long learning and skill-base to adapt accordingly (spring, 2007)
are trained to employ the "current best evidence in making decisions about the care of individual patients" (Spring, 2007)
Publicly available research levels for a range of clinical interests (Karl's language) - NHMRC in Australia provides ratings - level of evidence hierarchy structure - Seligman also refers to hierarchy structure...
CONSORT - checklist to discriminate between good/bad RCT studies based on relevance for individual context (Spring)
Therapy Advisor in Australia
APS Literature Review EBP interventions in the treatmen tof mental disorders
Common vocabulary across health disciplines = advantage for communication and facilitates transdisciplinary collaboration (Spring)
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Foster scientific/critical thinking approach ie formulate hypotheses based on detailed assessment and treat accordingly rather than treating intuitively (O'Gorman, Shapiro)
Availability of manualised treatments for specific conditions - again follow a process that can be measured for efficacy (Edwards, 2004)
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Challenges
Research
recognising treatment guidelines assume "homogenous" treatment needs based on the average patient and being able to translate these to the individual client and his or her context (Sprint, 2007)
often narrow focus of "research that has been graded for quality" (Spring) omits treatments/therapies that may be of more benefit to the individual client - need to express better re challenge to clinician*
evaluating what actually constitutes best research evidence AND having the competency to determine the question that needs to be addressed (Spring) which means a broader conceptualisation of science and scientitifc evidence incorporating both quantitative and qualitative methodologies and analytic frameworks (Bauer) but also the capacity to synthesise this research in order to guide practice with individual clients (Wilson Edwards)
translating "gold standard" RCT study of efficacy to individual client context ie evaluate external validity of RCT study (Spring)
"rapid access to the research evidence base at the point of care" (Spring, 2007) and experienced difficulties in reality of practitioners especially research that is directly applicable to practitioners (Wilsons et al. 2009)
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Gaps in the research literature esp behavioural science and preventative literature (Spring) because "our dominant research paradigms tend to yield data about homogenous majority groups receiving standard treatment in optimal settings" (Bauer 2007) - also useful for #3
capacity to evaluate portability of well-controlled efficacy studies to real world problems" Bauer 2007
Client Preferences
Communication skills to facilitate client capacity to make informed decisions and to provide informed consent (Spring)
capacity to recognise complexity of each individual context and then complexity of decision-making process to client - who will often be naive - capacity to mitigate client naivety... spring
integration of best available evidence with client preferences and available resources (financial, location/access to services, child care etc ) Spring
- Location rural v urban - organisational issues: availability of trained staff; clinic time specialised equipment (eg tests or technical resources eg MRI machine etc) - cultural factors of client eg attitude towards health issues (Karl Slides)
Clinical Expertise
Developing sufficient technical skill in informatics to yield a focussed and manageable number of relevant search results (Spring; Bauer)
Capacity to development sufficient rapport with each individual client recognising that rapport is a significant contributor to psychotherapeutic outcomes. (Spring)
easy to be misled about the particular aspects of one's practice that bring about positive change (Edwards) so developing sufficient reflexivity to recognise when clinical practices need to adapt to reflect best available research and how to adapt practice to reflect the evidence. (spring)
Updating and maintaining competency for manualised treatments as part of training doesn't always = competency given reduction in supervised training in EST's (Bauer, 2007) and the often understimated complexity associated with manualised treatments (Edwards 2004) . Manualised treatments also may restrict flexibility in the adaptation of the treatment approach to specific aspects of the client's personality and circumstances (Edward 2004)
Complexity of decision-making process that integrates client and research (Bauer, 2007; Satterfield pg 384) INCLUDING clinician limitations in expertise, and inevitable cognitive biases that influence judgement. (Satterfield) Need to have reflexive skills to manage these limitations...
gaining the necessary experience to make effective and appropriate decisions and the complex nature of determining how to address client concerns (Wilson)