Tweetchat: Are your treatment decisions evidence or craft-based?

Our sixth #ResNetSLT Tweetchat 'Are your treatment decisions evidence or craft-based?' took place on Wednesday 29th June.

Hosted by Mark Jayes and Dr Emma Pagnamenta the chat was based around this article. You can find the pre-chat information and questions here.

It was another lively chat with 28 participants, 268 tweets and a potential reach of 171,046. Thank you to everyone who contributed and followed the discussion.

The inspiration for the chat came from a study carried out by McCurtin & Clifford in 2015 who asked SLTs in Ireland about how they make treatment decisions.

Current understanding of EBP suggests we make decisions using evidence from four sources: i) research; ii) practice - our own and our colleagues' clinical experience; iii) individual patient characteristics; iv) contextual information.

The survey results suggested that the SLTs who responded make treatment decisions using evidence from two main sources: clinical experience (e.g. 'craft' knowledge) and contextual or pragmatic factors (e.g. resource availability).

We began the chat by discussing the role of clinical experience in our treatment decisions. There was agreement on the importance of experience but discussion about how this is integrated with clinical supervision, training, reflection and evidence.

Whilst participants recognised the vital importance of reflective practice, a concern was raised that we may not allow ourselves enough time to engage effectively in reflection.

It was suggested that clinical and student supervision can provide an opportunity for reflection but that we need to incorporate reflection within our daily practice.
Yes, we need to 'embed' #reflection as well as #EBP, it can't be the 'bolt on luxury' @SusanEbbels #ReSNetSLT
— Hazel Roddam (@HazelRoddam1) June 29, 2016
Interesting comments were made around how different experiences will lead to different practices, and how the availability of evidence can help to unify practice. But what do we mean by evidence?

There was discussion around whether clinical experience and knowledge can be considered as a form of evidence and the need for this to be backed up by research.

Participants recognised that clinical knowledge represents more than individual opinion.

The absence of evidence was also highlighted and how this acts as a driver for collecting practice-based evidence. Linked to this, one participant raised the issue of innovative practice, which may not have an existing evidence base.

It was agreed that it is important to establish the effectiveness of such practice using evidence from both clinical practice and research studies.

A strong theme was the need for SLTs to engage in shared decision making with patients, clients and 'agents of change' (e.g., carers, teachers). Participants identified that being able to present evidence about treatment options and enable clients to make decisions can feel challenging.

Evidence-based shared decision making tools such as decision aids can support us to do this. A useful online resource can be found here.

Participants reported that treatment decisions can be affected/restricted by local patterns of practice, resource availability and commissioning decisions.

There was agreement that SLTs can and should use evidence to try to challenge/change existing situations.
.@daisy_project @EmmaPagnamenta However, if local pressures and decisions lead to ineffective practice, they should be challenged #ResNetSLT
— Susan Ebbels (@SusanEbbels) June 29, 2016
Suggestions of how to support implementation of evidence into practice were shared, such as journal clubs, clinical research projects, MDT training, RCSLT CENs and regional Hubs, ASHNs and CAHPR hubs.

A number of online resources were also identified, including the RCSLT evidence-based clinical decision-making tool, new AHP evidence summaries from Cochrane Evidence for Everyday Allied Health and a site that promotes critical thinking about interventions.

The chat ended with a discussion about the interplay between developing the craft of therapy alongside learning to become an evidence-based clinician. This tweet sums up the chat:
@HazelRoddam1 @MCAsupporttool @EmmaPagnamenta Lets encourage shared decision making, overt reasoning and drive research. #ResNetSLT
— Arlene McCurtin (@ArleneMcCurtin) June 29, 2016
The link to the full transcript is here and the analytics here.

Suggested reading/further references

Cheung, G., Trembath, D., Arciuli, J. & Togher, L. (2013) The impact of workplace factors on evidence-based speech-language pathology practice for children with autism spectrum disorders, International Journal of Speech-Language Pathology, 15 (4), 396-406, DOI: 10.3109/17549507.2012.714797

Foster, A., Worrall, L. & Rose, M. (2015) "That Doesn't Translate": The Role of Evidence-Based Practice in Disempowering Speech Pathologists in Acute Aphasia Management. International Journal of Language & Communication Disorders, 50 (4), 547-563.

McCurtin, A. & Roddam, H. (2012) Evidence-Based Practice: SLTs under Siege or Opportunity for Growth? The Use and Nature of Research Evidence in the Profession. International Journal of Language & Communication Disorders, 47 (1), 11-26.