EBP 1 Flashcards
What is evidence based practice (EBP)?
The integration of the best research evidence with clinical expertise and patient values and circumstance.
What are the 3 legged stool of EBP?
- current best evidence
- clinical expertise
- patient values, preferences, characteristics
Describe current best evidence (5)
- Current scientific knowledge regarding the outcomes of a given psychological intervention in a given population, based on the current best-practice scientific methods of inquiry. E.g. from a Randomised Control Trial (RCT) of treatment efficacy
- Changes as new research findings emerge
- Ensures practices are not based on out-of-date research. As new findings emerge, our current understanding of best-practice changes
- Empirically supported treatments (ESTs): Treatments whose efficacy is supported by research findings. It’s important to consider the ESTs.
- Therapies that have been rigorously and efficaciously researched on.
Describe clinical expertise.
- Clinical expertise is required to make a judgement regarding whether specific evidence applies to the individual patient, and how to integrate this information into a clinical decision.
- Expertise developed via high quality training and commitment to remaining up-to-date with the latest research
- Requires the role of critical appraisal. Its not just about reading the research but also interacting and evaluating with the research (critically analyse the research paper).
What are the 5 A’s?
- Ask the question
- Acquire the evidence
- Appraise the evidence
- Apply the results
- Assess the outcome
How do you relate clinical expertise with current best evidence and patient values, preferences and characteristics in terms of providing treatment?
- Requires knowledge of mental health condition and associated factors (clinical expertise)
- Requires knowledge of current best practice for that condition and whether it fits with the patient’s values
- Different treatment might be appropriate depending on the severity and different treatment setting.
- Proficiency at delivering the intervention
Describe patient values, preferences, and characteristics. (6)
- Need to consider whether the research applies to the client.
- Can we use the evidence to apply treatment to client? Does it match the characteristic of the client?
- Feasibility of delivering the intervention in the setting?
- Feasibility of client accessing the intervention?
- E.g. how demanding is it? Is it affordable? How long does it go for? What might be the risks?
- Engaging clients in self-management, contra-paternalistic model
Sample answer of integration of 3 legged stool.
A clinical must be able to communicate their knowledge to the patient, be able to assess the patient and establish an alliance with them to deliver the best EST that matches the patient’s values characteristics, preferences and circumstances. This involves understanding other alternatives that the patient might want, the risks and benefits that applies to the patient, and whether the patient have sufficient access to the treatment (maybe in terms of therapy and how often therapy is).
The decision too administer the best EST needs to come from the best available research evidence. This involves looking through meta-analyses and critically appraising the quality and relevance of the treatments for your patient. This may involve integration of knowledge. The psychologist must then administer the treatment by first designing it based on all of the considerations above, conduct the treatment, analysing it, and reporting the results appropriately.
What are the strengths (1) and limitations (3) of clinical experience?
Strengths:
- Experience can result in more exposure to relevant knowledge and competency in delivering ESTs
Limitations:
- Experience — a collection of anecdotes based on your patients. Biased data? Cognitive biases?
Patients form the data that we’ve collected based on a certain treatment — biased as not all are recollected
- More experience may increase risk of over-confidence (as it doesn’t actually increase clinical expertise)
- Therapist drift
Therapists decide not to deliver key components of a therapy
Therapists ignore therapy’s limitations
Do therapy that they like
What are the levels of evidence in EBP? (6)
- Systematic reviews and meta analyses
- Critical appraisal of RCT
- RCT
- Cohort studies
- Case-control studies/case series
- Background info/expert opinion
What are systematic reviews?
A systematic review attempts to identify, appraise and synthesise all the empirical evidence that meets pre-specified eligibility criteria to answer a specific research question. Researchers conducting systematic reviews use explicit, systematic methods that are selected with a view aimed at minimising bias, to produce more reliable findings to inform decision making.
What are meta-analyses?
statistical analysis of findings in a systematic review, considered top of the evidence hierarchy (look for meta-analyses first)
What are RCTs?
- The RCT study design facilitates gathering evidence regarding the effectiveness of an intervention.
- Considered high quality scientific evidence (if well-conducted)
- Involves random allocation of sampled patients into either the experimental or control group
What are case-control studies/case series?
Descriptive studies, prone to selection bias, no control group.
What are Background info/expert opinion
Ideas, opinions, anecdotes?
- Lowest level of evidence (anecdotes are compelling but sometimes not true)
- No scientific methodology
- Prone to biases
- Anecdotes can be compelling
