Evidence into Practice: Integrating Judgment, Values, and Research

Abstract

Evidence into Practice: Integrating Judgment, Values, and Research provides a wealth of information to guide readers in tackling one of the most salient challenges faced by practising clinicians today: balancing clinical expertise and research evidence with patient values and choices in decision making for health care practice. Written primarily by Laurita M. Hack and Jan Gwyer, the book also includes contributions from physical therapists, physicians, bioethicists, and scholars from universities and health care institutions across the United States. Although the focus is on physical therapy practice and most of the examples therefore come from physical therapy, the topic of evidence-based practice (EBP) and the subject matter presented are relevant to all types of clinicians. The authors approach EBP by breaking it down into three components, exploring each aspect in a separate section before tying them together in a discussion of EBP and knowledge translation. Part 1 focuses on clinical judgment and opens with an exploration of language in practice. The authors provide a useful discussion of terminology and how it is used to categorize and describe clients, issues, and different steps in the process of physical therapy practice. Included is a reflection about the influence of language in shaping perceptions and practice. The authors consider types of decisions required in physical therapy practice and common reasoning or clinical decision-making strategies before examining the literature on errors in practice and discussing potential clinical reasoning biases. This section closes with a brief look at clinical decision-making tools. Part 2 is broadly centred on understanding and respecting patient values, differences, and circumstances. An exploration of aspects of communication that can inhibit or enhance the development of therapeutic relationships and information sharing leads into an in-depth examination of interviewing skills and approaches. Also included in this section is an overview of qualitative research methods, illustrating how clinicians can apply qualitative findings to glean information about client characteristics and experiences. Finally, the authors examine the U.S. health care system and how service delivery and payment structures, in combination with patient characteristics, may affect patient care. The focus of Part 3 is research evidence. The authors look at the different types of research evidence and offer a detailed guide to using search engines and databases to find targeted research; they provide in-depth guidance on evaluating the quality of research, through an examination of the research methods used to approach the question, and on applying findings from different research approaches to practice. In addition to the previously mentioned chapter about qualitative research methods in Part 2, this section is particularly helpful for clinicians who may be less familiar or comfortable with accessing research information directly. Part 4 ties together all the information provided in Parts 1–3 to examine the translation of evidence and knowledge into practice. Drawing from various documentation guidelines, this section also includes a discussion of documentation practices and how these can enhance or impede patient care and, in turn, practice. Finally, the authors examine the potential for quality improvement and use an actual programme initiative to model how clinicians could examine practices and processes in their own settings and envision the potential for quality improvement. Hack and Gwyer carefully build the foundation for understanding and applying EPB. Their presentation is clear and well organized; throughout the text, tables and figures are incorporated to clarify information and provide helpful comparisons. Each chapter concludes with suggestions for further learning, as well as self-assessment questions to engage readers in considering the content of the chapter and how it might apply to their own practice. The authors guide clinicians in reflecting on the integration of theory and evidence, in consideration of patient values and circumstances, to achieve best practice outcomes. This text aims to help clinicians at all stages of their career and would be a most helpful guide for any practitioner seeking to further develop the skills to provide evidence-based care.