Locating the Best Available Research

This chapter reviews unfiltered information sources, which contain “virtually everything” published, without filter or fetter. Unfiltered information can be found in a wide variety of online search tools and bibliographic databases, such as MEDLINE, PsycINFO, and CINAHL, and is generally the basis for all other kinds of research evidence. This chapter also introduces specialized evidence-based search engines. A weakness of unfiltered information is that it needs to be analyzed and synthesized, which can prove time-consuming. To facilitate the retrieval of unfiltered information, the chapter describes the advanced approach of using controlled vocabularies such as medical subject headings (MeSH). The chapter concludes by covering resources for accessing evidence on behavioral health tests and measures, including test reviews, test information databases, and test publishers.

Disseminating, Teaching, and Implementing Evidence-Based Practices

Moving research evidence from science to service, from the lab bench to the bedside, poses a challenge for evidence-based practices (EBPs). Translation(al) research inclusively refers to the process of successfully moving research-supported discoveries into established practice and policy. This chapter begins with synopses of the empirical research on predicting adoption of EBP and the barriers to its implementation. The chapter then reviews effective methods for disseminating, teaching, and implementing EBPs. Like EBP itself, the new field of implementation science sensitively integrates the best research evidence, clinical expertise, and staff characteristics and preferences into deciding what works in each unique healthcare system.

Incorporating Evaluation and Ethics

The final core step in evidence-based practice (EBP) is evaluating the effectiveness of the entire process: the E(valuation) in the mnemonic AAA TIE. In the literature, this skill is typically referred to as monitoring, measuring, or auditing clinical performance. This chapter reviews the evaluation of EBP implementation at three levels: the individual practitioner, the program or administrative unit, and the profession as a whole. The chapter then focuses on risk management, liability standards, and ethical issues—matters typically ignored when considering EBPs. The key ethical considerations in EBP revolve around competence, consent, and public statements; all of these are considered according to the American Psychological Association’s ethics code, which is used as an exemplar for the various codes of behavioral health professions.

Integrating the Patient and the Clinician With the Research

This chapter demonstrates how research is integrated with the two other pillars of evidence-based practice (EBP): clinical expertise and patient characteristics. Research alone never suffices for making clinical decisions, nor does the simple extrapolation of research qualify as EBP. The chapter begins by correcting pernicious myths about EBP and then discusses enlarging clinical decision-making by adding the clinician and the patient into the mix. The chapter describes several ways in which the three pillars of EBP can be integrated and considers what to do when they cannot be integrated, particularly in complex cases. Clinicians will ultimately adopt, adapt, or abandon a research-supported intervention for a specific case. Finally, the chapter reviews the research on being responsive to patients’ transdiagnostic features, such as preferences, stages of change, and culture.

Reading and Interpreting the Research

Evidence-based practice depends on research as its key source, and that research follows one of several designs. This chapter identifies commonly used research designs, terms used in their application, and the special strengths and weaknesses of each design. Designs include randomized clinical trials, quasi-experimental designs, surveys, and case study methods. Discussion of multivariate methods covers the important role of partial correlation and its applications in multiple regression, structural equation modeling, factor analysis (both exploratory and confirmatory), and mediator analysis. The chapter further details the role of the hypothesis in the designs, types of errors (I and II) affecting conclusions, and the role of power in statistical tests. Critical factors in drawing causal conclusions from the various designs receive special attention throughout.

Asking the Right Questions

This chapter provides a guide to the first core skill of evidence-based practice (EBP): formulating a specific, answerable question. This skill lies at the heart of accessing the best available research. To practice EBP clinicians must first form an answerable clinical question; otherwise they will likely incur frustration and waste time once they embark on their literature search. The chapter introduces several types of questions, including background and foreground questions. The chapter also provides step-by-step instructions for formulating clinical questions using the PICO format, which encourages clinicians to identify the patient, intervention, comparison, and outcomes relevant to the patient. It concludes with a discussion of how to ensure that questions reflect the patient’s preferences and how to prioritize questions.

Translating Research Into Practice

This chapter assists practitioners in translating the research evidence into direct applications to their patients. It reviews the imperative of translational research and the stance of the reflective practitioner. The chapter helps practitioners translate the results of randomized clinical trials into practice by applying the CONSORT checklist. It considers potential harms that might accrue to patients in applying the research. The chapter also examines the process of identifying discredited practices—interventions that do not work—and reflects on how to proceed in the face of inconsistent evidence. The chapter concludes by applying clinical decision analysis, using decision trees to explore choices at critical junctures.

Appraising Research Reports

Assessing and interpreting research reports involves examination of individual studies as well as summaries of many studies. Summaries may be conveyed in narrative reviews or, more typically, in meta-analyses. This chapter reviews how researchers conduct a meta-analysis and report the results, especially by means of forest plots, which incorporate measures of effect size and their confidence intervals. A meta-analysis may also use moderator analyses or meta-regressions to identify important influences on the results. Critical appraisal of a study requires careful attention to the details of the sample used, the independent variable (treatment), dependent variable (outcome measure), the comparison groups, and the relation between the stated conclusions and the actual results. The CONSORT flow diagram provides a context for interpreting the sample and comparison groups. Finally, users must be alert to possible artifacts of publication bias.

Reading and Interpreting the Research

This chapter reviews the numerical indices most frequently encountered in evidence-based practice (EBP), with an emphasis on practical interpretation. The research that fuels EBP abounds with numbers. Making sense of and applying that research requires familiarity with those numbers. This chapter covers features of the normal curve, standard errors, and confidence intervals for both test scores and statistics. Various measures of effect size and their practical interpretation receive special attention. Especially when investigating a condition (for example, depression or alcoholism), a host of rates and ratios play a prominent role in interpreting evidence, including the odds ratio, sensitivity and specificity of measures, false positives and false negatives, and positive and negative predictive power. The chapter also discusses the effect of outliers on research results.

Locating the Best Available Research

This chapter discusses the steps EBP clinicians should take in finding evidence that addresses their clinical questions: searching background information resources, which provide overviews of topics, and then moving to filtered information resources, which provide access to timesaving, synthesized information. To help clinicians navigate these resources, the chapter summarizes basic search concepts that are applicable across the resources, such as Boolean operators, truncation, wild cards, and limits. The chapter describes key background information sources, such as eMedicine, textbooks, and Wikipedia. It then discusses key filtered information sources, including the Cochrane Database of Systematic Reviews, BMJ Clinical Evidence, and several evidence-based journals. The chapter provides tailored tips for optimal searching within each resource introduced.