Editors: Tammy Hoffmann BOccThy PhD; Sally Bennett BOccThy PhD; Chris Del Mar MD Elsevier Australia, 2010; 349 pages; $A79.00.
One more book on evidence-based practice!! What does this book say that is different? The three editors and 28 contributors of this 16-chapter book are from across the health professions (occupational therapy, physiotherapy, speech language therapy, radiation therapy, medicine, nursing, speech language pathology, dietetics and podiatry) with a wide range of expertise in evidence-based practice, education, research, management, knowledge translation and exchange, informatics and health policy. As a result, it is refreshing to see a wide range of clinical scenarios and examples throughout the book that virtually any healthcare professional can relate to. There is a strong emphasis on maintaining the focus of the guidance for the clinician/health professional. The presentation of ideas for the most part is quite accessible.
The book is framed by Hoffmann, Bennett and Del Mar as a basic knowledge resource on evidence-based practice. Although many of the early chapters refer to understanding research evidence, the organisation of the discussion by clinical questions, evidence and clinical examples is very helpful to a beginning practitioner or one new to evidence-based practice. For example, chapters are organised around evidence about effects of interventions, evidence about diagnosis, evidence about prognosis, and evidence about clients' experiences and concerns. For each of these chapters, there is an accompanying chapter addressing clinical questions with examples from a variety of health disciplines. This approach addresses the frequent criticism of the overemphasis on evidence-based interventions with little attention to evidence related to diagnosis, prognosis and most importantly to clients' experiences and concerns as well as an overemphasis on examples from medicine with little attention to other health disciplines.
An introductory chapter on finding evidence is appropriately written to reflect on approaches to identify evidence by type of clinical question and the type of evidence. The authors have resisted from writing a research methodology book and discussed appraisal of evidence with the clinician in mind. Critical appraisal of research is a cornerstone of the book and heavily exemplified through practical scenarios. Moreover, those of us who focus on experiences of clients, families and groups will be delighted to see a chapter devoted to the appraisal of qualitative research. A short primer on well-established qualitative research methodologies is included.
Hoffmann et al. have also tried to fill the gap in evidence-based practice literature by allocating a chapter each on 'how to talk to clients about evidence', 'clinical reasoning' and 'implementing evidence into practice'. These are topic areas that have not been adequately covered in other books about evidence-based practice. Although these topics are covered as introductory discussions, the authors are commended for including these in a comprehensive book about evidence-based practice. It would have been appropriate for the authors to include resources for more advanced reading in these areas and pointed to areas not covered such as the role of decision support tools in implementation, developing links with organised networks that support evidence-based practice (e.g. National Collaborating Centres in Public Health in Canada) and the role of research evidence in policy formulation at a broader system level.
A most interesting and again commended effort is made to support health professionals in understanding the broadest definition of evidence-based practice, that is, to integrate knowledge from research, clinical/professional expertise, clients' values and preferences and context within which the care is delivered. What is most helpful, however, is that the authors have taken a step further to provide guidance about the process of integration of the different types of knowledge. It is ironic but thankfully appropriate that we are now once more engaging in a dialogue of what it means to be a professional and the balancing role of the professional in using both the art and science of healthcare. It is hoped that further work is conducted and written about integration of knowledge and how it can serve to address varied contexts and situations of uncertain evidence.
Courses and orientation to evidence-based practice need to go beyond knowing how to pose Patient, Intervention, Comparison, Outcome (PICO) questions and critical appraisal of research studies, even though there is much to be learned here. The critical junction of the evolution of evidence-based practice is that we have come full circle to ensure that the lessons learned from propositional knowledge (theoretical, research and scholarship) are integrated with professional craft knowledge and personal knowledge. And further, that this knowledge is used in the context of client-centred care and the particularities of the sociopolitical and cultural contexts that we find ourselves with our clients. Engaging and supporting self-reflection and articulating knowledge that may have become tacit or embodied knowledge will help to further our collective understanding. Making this journey through our individual discipline and interprofessional lens will also create greater value for our clients.
The book is not just another book on the subject of evidence-based practice but rather a valuable resource with practical and user-friendly examples for a range of healthcare professionals. It brings forward, in accessible language, the more recent discourse in evidence-based practice, such as different types of clinical questions (diagnosis, prognosis, interventions and clients' experiences and concerns), the integration of different types of knowledge and how to address discussion of evidence with clients.
Tazim Virani & Associates Consulting Firm Markham, Ontario, Canada