The place of service-user expertise in evidence-based practice

2016 ◽  
Vol 17 (1) ◽  
pp. 3-20 ◽  
Author(s):  
Kate Davies ◽  
Mel Gray
Keyword(s):  
Lived Experience ◽  
Service User ◽  
Evidence Based Practice ◽  
Evidence Based ◽  
Service Users ◽  
Pragmatic Approach ◽  
Strong Argument ◽  
User Expertise ◽  
User Knowledge ◽  
Based Medicine

Summary This article considers the place of service-user knowledge and expertise within an evidence-based practice perspective. It makes a strong argument that client involvement is a core principle of Sackett et al.'s foundational approach in evidence-based medicine. In so doing, it draws on research on service-users' perceptions and experiences of evidence-based practice. Findings For service users, evidence-based practice lacks relevance and trustworthiness unless it explicitly factors in the expertise of service users themselves. Evidence-based practice is seen to have merit as a tool for enhancing accountability, but service users see a role for themselves at individual and representative levels in the process of evidence-based practice. They place a high value on the expertise derived from lived experience, and recognise that fluctuations in capacity and changes in circumstances of many service users require a flexible approach to their participation in decision making. A pragmatic approach to the conceptualisation of evidence is recommended, which not only maintains scientific rigour inherent in evidence-based practice but also more strongly emphasises the process of analysing evidence appropriate to a particular individual's preferences and circumstances. Applications For human service practitioners, this study emphasises the need to develop professional skills in assessing the capacities, circumstances and preferences of clients and analysing and applying evidence for practice in ways that conform to a client-centred approach. It also indicates a need for researchers and practitioners to recognise and value service-user expertise.

scholarly journals Opening up evidence-based policy: exploring citizen and service user expertise

2020 ◽  
Vol 16 (2) ◽  
pp. 199-208
Author(s):  
Ellen Stewart ◽  
Jennifer Smith-Merry ◽  
Marc Geddes ◽  
Justyna Bandola-Gill
Keyword(s):  
Service User ◽  
Evidence Based ◽  
User Expertise ◽  
Evidence Based Policy ◽  
Opening Up

scholarly journals Is the Movement of Evidence-based Practice a Real Threat to Music Therapy?

2013 ◽  
Vol 13 (2) ◽  
Author(s):  
Masako Otera
Keyword(s):  
Music Therapy ◽  
Evidence Based Practice ◽  
Evidence Based ◽  
Clinical Expertise ◽  
Music Therapists ◽  
Treatment Protocols ◽  
Empirically Supported ◽  
Standardized Treatment ◽  
The Individual ◽  
Based Medicine

The author discusses what music therapists must work on to establish Evidence-based practice (EBP) in music therapy by referring to Saito's discussion of the misunderstandings and various interpretations of Evidence-based medicine (EBM), the issue of Empirically Supported Treatments (ESTs) in EBP in psychology (EBPP), and related discussions. Although the EBP movement tends to be recognized as a threat to music therapy, some recent discussions of EBM and EBP are encouraging for the development of EBP in music therapy. This paper shows that an integration of evidence of multiple types with clinical expertise and the individual needs in clients has become a consensus of EBP. However, the issues related to conducting Randomized controlled Trials (RCTs) and employment of standardized treatment protocols in music therapy have persisted as difficult problems. Because the issue of EBP is very complex and easily biased, effective learning of this issue should be promoted among music therapists so that they can successfully relate to the EBP movement and bring benefits to the field of music therapy. The author suggests that incorporating the ideas of EBP positively into the field of music therapy and constructing methodologies and theories will enhance EBP.

scholarly journals Evidence-Based Medicine, Systematic Reviews, and Guidelines in Interventional Pain Management, Part I: Introduction and General Considerations

2008 ◽  
Vol 2;11 (3;2) ◽  
pp. 161-186
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
Health Care ◽  
Pain Management ◽  
Systematic Reviews ◽  
Evidence Based Medicine ◽  
Critical Appraisal ◽  
Evidence Based Practice ◽  
The United States ◽  
Evidence Based ◽  
Interventional Pain Management ◽  
Based Medicine

Evidence-based medicine, systematic reviews, and guidelines are part of modern interventional pain management. As in other specialties in the United States, evidence-based medicine appears to motivate the search for answers to numerous questions related to costs and quality of health care as well as access to care. Scientific, relevant evidence is essential in clinical care, policy-making, dispute resolution, and law. Consequently, evidence based practice brings together pertinent, trustworthy information by systematically acquiring, analyzing, and transferring research findings into clinical, management, and policy arenas. In the United States, researchers, clinicians, professional organizations, and government are looking for a sensible approach to health care with practical evidence-based medicine. All modes of evidence-based practice, either in the form of evidence-based medicine, systematic reviews, meta-analysis, or guidelines, evolve through a methodological, rational accumulation, analysis, and understanding of the evidentiary knowledge that can be applied in clinical settings. Historically, evidence-based medicine is traceable to the 1700s, even though it was not explicitly defined and advanced until the late 1970s and early 1980s. Evidence-based medicine was initially called “critical appraisal” to describe the application of basic rules of evidence as they evolve into application in daily practices. Evidence-based medicine is defined as a conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. Evidence-based practice is defined based on 4 basic and important contingencies, which include recognition of the patient’s problem and construction of a structured clinical question, thorough search of medical literature to retrieve the best available evidence to answer the question, critical appraisal of all available evidence, and integration of the evidence with all aspects and contexts of the clinical circumstances. Systematic reviews provide the application of scientific strategies that limit bias by the systematic assembly, critical appraisal, and synthesis of all relevant studies on a specific topic. While systematic reviews are close to meta-analysis, they are vastly different from narrative reviews and health technology assessments. Clinical practice guidelines are systematically developed statements that aim to help physicians and patients reach the best health care decisions. Appropriately developed guidelines incorporate validity, reliability, reproducibility, clinical applicability and flexibility, clarity, development through a multidisciplinary process, scheduled reviews, and documentation. Thus, evidence-based clinical practice guidelines represent statements developed to improve the quality of care, patient access, treatment outcomes, appropriateness of care, efficiency and effectiveness and achieve cost containment by improving the cost benefit ratio. Part 1 of this series in evidence-based medicine, systematic reviews, and guidelines in interventional pain management provides an introduction and general considerations of these 3 aspects in interventional pain management. Key words: Evidence-based medicine, systematic reviews, clinical guidelines, narrative reviews, health technology assessments, grading of evidence, recommendations, grading systems, strength of evidence.

Commentary on a “unified approach to behaviours that challenge”: implementing evidence-based practice – a clinician’s perspective

2020 ◽  
Vol 25 (3) ◽  
pp. 163-167
Author(s):  
Steven Carnaby
Keyword(s):  
Learning Disabilities ◽  
Lived Experience ◽  
Evidence Based Practice ◽  
Evidence Based ◽  
Clinical Expertise ◽  
Unified Approach ◽  
Content Type ◽  
Effective Implementation ◽  
Adults With Learning Disabilities

Purpose This paper aims to provide a commentary on papers in this special edition concerning the implementation of evidence-based practice from a clinician’s perspective. Design/methodology/approach The commentary makes a number of points drawing on both recent literature and the author’s own experience working as a clinician with children and adults with learning disabilities including those who are autistic whose behaviours can challenge themselves, their parents, carers and support networks. Findings Effective implementation requires clinical expertise to operate within a context of collaboration and partnership working, where co-production with those who have lived experience ensures that what clinicians offer resonates and contributes to improvements in quality of life for all. Originality/value The paper will be of value to clinicians working alongside children and adults with learning disabilities and their families, particularly clinical psychologists and behaviour specialists, and to other stakeholders wanting to enable and facilitate the development of high-quality support.

Evidence-Based Paediatric Oncology

2020 ◽  
pp. 46-51
Author(s):  
Leontien C.M. Kremer ◽  
Erik A.H. Loeffen ◽  
Robert S. Phillips
Keyword(s):  
Patient Care ◽  
Evidence Based Medicine ◽  
Evidence Based Practice ◽  
Guideline Development ◽  
Daily Practice ◽  
Paediatric Oncology ◽  
Evidence Based ◽  
The World ◽  
Optimal Patient Care ◽  
Based Medicine

The practice of evidence-based medicine (EBM) is very important in delivering optimal patient care and the terms evidence-based medicine, or evidence-based practice, are used all around the world. This chapter discusses evidence-based paediatric oncology, including its history, an outline of what EBM is, EBM in paediatric oncology, steps in evidence-based paediatric oncology for a user of EBM, steps in guideline development as an implementer of EBM, common criticisms of EBM, and the future of EBM. The chapter gives an overview how EBM can be used in a non-exhaustive but still comprehensive way in daily practice of care for children with cancer, and which tools are available for paediatric oncologists. The majority of the chapter focuses on how to learn to become a skilled user of EBM.

An exemplar of GP commissioning and child and adolescent mental health service partnership

2016 ◽  
Vol 24 (1) ◽  
pp. 26-37 ◽  
Author(s):  
Ayla Humphrey ◽  
Lynne Eastwood ◽  
Helen Atkins ◽  
Maris Vainre ◽  
Caroline Lea-Cox
Keyword(s):  
Mental Health ◽  
Capacity Planning ◽  
Service User ◽  
Adolescent Mental Health ◽  
Child And Adolescent ◽  
Evidence Based ◽  
Service Users ◽  
Content Type ◽  
Health Report ◽  
Shared Goals

Purpose – The purpose of this paper is to draw attention to commissioning and service structures enabling implementation of evidence-based cost-effective care as illustrated by the “1419” young people’s service treating mild to moderate severity mental health difficulties in teenagers old 14 to 19 years. The authors describe relevant local contextual factors: “relational commissioning”, demand capacity planning and a receptive and safe clinical context. Design/methodology/approach – The authors used a participant observer qualitative research design to describe commissioning and service design. Treatment outcomes were analysed using a quantitative design and found significant improvement in service user mental health and daily function. These results will be reported elsewhere. Findings – The dynamics and structures described here enabled clear shared goals between service user, service purchaser, service provider and service partners. The goals and design of the service were not static and were subject to ongoing development using routine outcome measures and conversations between referrers, commissioners, service users and within the team about what was and was not working. Research limitations/implications – The methods are limited by the lack of a prospective systematic evaluation of the implementation process and by the time limitations of the service. Practical implications – Implementation of whole system change such as that envisioned by Children and Young People’s Improving Access to Psychological Therapies requires consideration of local context and process of implementation. The authors suggest key factors: consideration of “relational commissioning” with purchasers, providers and service users designing services together; case-level collaboration between services and partner agencies; smaller child and adolescent mental health teams eliminating competing task demands, permitting speed of action, providing psychological safety for staff, promoting shared goals and innovation; rigorous demand/capacity planning to inform funding. Social implications – The failings of child and adolescent mental health services (CAMHS) are detailed in the Department of Health report “Future in mind: promoting, protecting and improving our children and young people’s mental health and wellbeing” (2015). The aims of the report are contingent on the ability of local health providers to implement its recommendations. The authors provide a theoretical approach to enable this implementation. Originality/value – To date there are no published papers addressing the key characteristics enabling implementation of evidence-based practice within CAMHS. The unique experience in forming the“1419” service has important implications nationally and brings together evidence of an effective service within a theoretical underpinned context.

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