Thursday, 28 July 2016

Tweetchat: 'That doesn't translate’ - the role of evidence-based practice in disempowering speech pathologists in acute aphasia management

Our seventh Tweetchat 'That doesn't translate’: the role of evidence-based practice in disempowering speech pathologists in acute aphasia management’ took place on Wednesday 27th July.

We were delighted by the reach of the chat, hosted by Dr Hazel Roddam, with 37 participants sending 251 tweets that were delivered to 126,391 linked accounts.

Thank you to everyone who contributed and followed the chat. Participants included SLTs from across the UK and in Australia as well as other AHPs.

We know that people from other EU countries were also watching the conversation. We were particularly delighted that a number of people joined the Tweetchat for the first time – hope you enjoyed it!

The paper reports an exploratory study of speech and language therapists working in Australia with patients who have acute aphasia and it uncovered some startling insights into the direct impact of professionals' values and attitudes on their clinical practice.

The SLTs in this study reported feeling so overwhelmed by the published research literature that this generated a resistance to reading or applying any of the evidence.

This sense that the principles of EBP effectively made the clinicians feel disempowered needs to be urgently addressed in pre-registration clinical education, as well as through continuing education with qualified clinicians.

There also remains a challenging question of whether these same findings would be generated with groups of SLTs working with other clinical populations, or in other countries? And to what extent these themes may be identified within other groups of AHPs?

We began the chat by discussing that up until now most published reports indicated that SLTs and other healthcare professionals stated positive attitudes to EBP.

This is an important paper because it reveals deeper insights into alternative perspectives of EBP. This matches with a recent survey of UK SLT's conducted by the RCSLT.

Many of our Tweetchat participants agreed that these findings matched with their own experiences. A discussion took place about implications of this for pre and post qualification training.

Some interesting conversations were started about comparisons in EBP teaching in Australia and the UK.

Many people suggested that an important way forward is for clinical therapists to work together with academics in practice based and practice led research.

We also need to understand better the importance of implementation research designs and strategies that can more effectively support embedding of EBP in clinical practice.

The chat was based around this article - we would like to thank @IJLDC for making this paper open access for the next four weeks from the date of the Tweetchat.

You can find the pre-chat information and questions here.

The transcript can be found here and the stats/analytics are here.

Suggested reading/further references

Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science.

Knowledge Translation in Health Care: Moving from Evidence to Practice.

National Collaborating Centre for Methods and Tools (2010). Ottawa Model of Research Use: A Framework for Adopting Innovations. Hamilton, ON: McMaster University. (Updated 30 August, 2010).

Monday, 18 July 2016

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.
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.
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:
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.

Thursday, 14 July 2016

Tweetchat: So good to be involved - PPI in research

Our fifth Tweetchat 'So good to be involved: PPI in research' took place on Wednesday 25th May.

We were delighted by the reach of the chat, hosted by Dr Rebecca Palmer and Dr Emma Pagnamenta, with 37 participants sending 482 tweets that were delivered to 728,787 linked accounts.

We were particularly pleased by the interdisciplinary nature of the chat and the involvement of #whywedoresearch. Thank you to everyone who contributed and followed the chat.

Patient and public involvement (PPI) is promoted at all stages of research, with everyone having a right to be involved.

However, the high level of communication skills often required precludes the involvement of people with communication difficulties.

We began the chat by sharing examples of how patients/service users are being involved in research. Many different ways of involving patients and the public were shared.

These ranged from advisory groups, inputting to study materials, giving research ideas, using video conversation, observation, focus groups and art projects.

Some projects have trained people with communication difficulties to be interviewers.

There was agreement that PPI needs to happen from the very start of the research process. As stated during the conversation - if we don't involve patients in design how do we know we are researching what is needed?

A discussion took place about the similarities between PPI and use of co-production methods in research. It was suggested that co-production of new interventions or assessment tools etc could be part of a PPI group role.

The benefits of involving our services users can be profound. Contributors to the chat talked about better quality research - research running more smoothly, greater insight into needs and priorities and a greater commitment to the research.

There are benefits beyond the research itself, with PPI giving opportunities to practice conversation skills, an opportunity to be listened to, social time and support for carers.

But PPI is not without its challenges. Patients need support to engage with the research process, form transport provision and flexibility in location and timing to strategies to support communication and support with waiting for AAC users to respond.

Research needs to be explained in accessible terms. There needs to be an acceptance from the researchers that their needs and patients needs and priorities do not always match.
Advice was shared to overcome some of the barriers to PPI such as applying to local NIHR Research Design Services for funds to cover transport expenses or building in these costs from the outset. Flexibility and being adaptable were also discussed.

An important theme from the discussion was the investment in building relationships, maintaining these and giving back when participants need advice.

Here are two of our favourite tweets to sum up the chat:

The Tweetchat was based around this article.

Reflections on participating in the research group were elicited through videoed interviews. You can see some of the interviews in this film.

You can find the pre-chat information and questions here.

The link to the full transcript is here and the analytics here.

Suggested reading/further references

Harrison & Palmer (2015). Exploring patient and public involvement in stroke research: a qualitative study. Disabil Rehabil, 37 (23): 2174-83.

View this film from the CACTUS Aphasia Research Group.

Read Chris Welburn's first hand account of being involved in shaping aphasia research as a person with aphasia.

INVOLVE hosts a research library on public involvement, a 'Putting it into Practice' database and other resources.