Exploring the relationship between client perspectives, clinical expertise and research evidence

Guest Editor: David Trembath

Abstract

Purpose: This paper examines the relationship between components of evidence-based practice (clinical expertise, patient perspective and research evidence).

Method: Findings are examined from two research programs: the Better Communication Research Program and Child Talk, including exploratory studies of the views of parents and children regarding speech-language pathology and studies of current practice by SLPs in England. Systematic reviews of the research literature were also undertaken. The paper analyses relationships between outcomes valued by children and parents and those reported in the literature and in practice, parents’ perspectives regarding intervention in comparison with clinicians’ reports of practice and the extent to which research evidence underpins current practice is examined.

Result: Parents and children value functional outcomes and positive experiences; these are not routinely measured in research or practice. Therapy is perceived positively by most parents; however, some are ambivalent and less clear about the rationale. Commonly used interventions are supported by evidence, but there are gaps regarding some critical therapy components.

Conclusion: The paper discusses four challenges to evidence-based practice: the consistency and clarity of descriptions of interventions; consensus based models of practice; understanding of the mechanisms of change; and, finally, the operationalization of client preferences within an evidence-based practice framework.

Keywords::

• Evidence-based practice
• clinical expertise
• patient perspectives

Acknowledgements

I am grateful to all those who took part in the Better Communication Research Program and Child Talk research program including parents, children, speech & language therapists and early years professionals who participated in focus groups, national workshops and surveys.

I am pleased to acknowledge the contributions of leading members of the two research programs of which I was privileged to be a part. The reflections, which led to the keynote presentation on which this article is based, are my own, but are undoubtedly influenced by many hours of discussions and fruitful collaborations with my esteemed colleagues:

Professors Geoff Lindsay, Julie Dockrell and James Law were lead members of the Better Communication Research Programme. Other key researchers involved in the work quoted here include: Professor Jane Coad, Dr Yvonne Wren, Dr Helen Hambly and Anne Ayre.

Members of the Child Talk research program who were involved in the work quoted here: Dr Julie Marshall, Dr Gaye Powell, Professor Juliet Goldbart, Dr Yvonne Wren, Professor Jane Coad, Professor Norma Daykin, Professor Jane Powell, Linda Lascelles, Professor William Hollingworth, Professor Alan Emond, Professor Tim J. Peters, Dr Jon Pollock, Cres Fernandes, Jenny Moultrie, Sam Harding, Dr Lydia Morgan, Dr Helen Hambly, Naomi Parker and Dr Rebecca Coad.

The Better Communication Research Programme was initially funded by the UK Department for Children, Schools and Families (DCSF) and funding was continued by the Department for Education (DfE).

“Child Talk” is an independent research program funded by the National Institute for Health Research (NIHR) under its Program Grant for Applied Research Program (Grant Reference Number RP-PG-0109-10073). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

Declaration of interest: The author reports no conflicts of interest. The author alone is responsible for the content and writing of the paper.