1.7 Evidence-based practice

A critical element of our work as speech pathologists, and the provision of quality services, is evidence-based practice (EBP).  The first standard (standard 1.1) in the Professional Standards for Speech Pathologists in Australia (SPA, 2020) is: Provide ethical and evidence-based practice.  The purpose of EBP is to assist health professionals with clinical decision making.  To make appropriate and informed clinical decisions, we need to integrate information from a number of different sources.

This video provides an overview of EBP.

^{EPB – The basics by Speech Pathology Australia}

EBP in speech pathology has been defined as “an approach in which current, high-quality research evidence is integrated with practitioner expertise and client preferences and values, into the process of making clinical decisions” (ASHA, 2005, p. 1).  There are two common models used to further describe and outline EBP.  The two models are similar but conceptualise evidence relating to the ‘practice context’ differently.

The first is referred to as the E³BP model conceptualised by Dollaghan (2007).  In this model, three (3) types of equally-relevant evidence should be integrated into decision-making:

1. Research-based evidence  (the best available evidence from systematic research with high internal validity that applies to a given clinical question);
2. Practice-based evidence (evidence which is collected in a clinical setting and which can have greater real-life application; includes clinical expertise);
3. Informed by patient or client preferences (how clinicians develop a shared understanding of preferences, values and goals of clients and their families/communities so the most appropriate service response is provided).

An enhancement to this model was proposed by Hoffman, Bennett, and Delmar (2013) who suggest it is necessary for health professionals to also consider the changing and diverse characteristics of the practice context in which you are working and interacting with clients.  The practice context includes potential service characteristics and constraints, the resources that may or may not be available in your practice context, as well as the broader policies and procedures associated with the practice context.  Therefore, the E³BP has been expanded to a four (4) component model (Figure 3):

1. Research-based evidence;
2. Information from the practice context;
3. Patient values, circumstances etc;
4. Clinical expertise.

There are a range of useful resources that will assist with your learning, understanding and application of EBP.  These include:

• Evidence-based practice for speech pathology in Australia
• Speechbite
• ASHA Evidence-based practice
• ASHA Evidence Maps
• ASHA Practice Portal
• JCU InfoSkills Toolkit
• The DECIDE Framework