The Advisory Committee on Evidence-Based Practice (ACEBP), ASHA's newest standing committee, held its initial meeting in May at the National Office. Building upon the work of the 2004 Co-Coordinating Committee on Evidence-Based Practice and ASHA's Research and Scientific Affairs Committee, ACEBP is charged with:
- establishing a set of terminology and definitions related to EBP for consistent use throughout ASHA
- identifying and prioritizing clinical questions to be addressed
- convening panels of independent knowledgeable reviewers to conduct evidence reviews on identified clinical
- establishing processes for the conduct and dissemination of evidence reviews; and
- advising National Office staff on members' needs in the area of EBP.
In addition to ACEBP, the Association has also established the National Center for Evidence-Based Practice in Communication Disorders (N-CEP), launched a multi-year Focused Initiative on EBP, and integrated EBP into the ASHA Strategic Plan. In short, EBP is everywhere. But what does it truly mean for ASHA members?
Over the next year, members will be introduced to the basic principles of EBP and provided with the necessary support and tools to assist them with integrating quality evidence into their practice. To accomplish this, three broad themes—education, ongoing support, and the synthesis of the evidence—have emerged relative to the Association's initiatives on EBP.
The first priority is education of ASHA members as to what EBP is (and is not) and development of the skills necessary for the adoption and integration of EBP into everyday clinical practice. A major part of this education is de-bunking some of the myths that surround EBP (see Christine Dollaghan's excellent article on this in the April 13, 2004 issue of The ASHA Leader). Chief among these is the myth that clinicians should be turned into "robots," basing their treatment decisions solely on empirical evidence. A fundamental principle underlying ASHA's approach to EBP is that clinical decisions are ideally guided by evidence, the clinician's own expertise and experience, and the values and perspective of the client/patient.
For many ASHA members, integrating and making sense of the evidence may mean acquiring some new skills. For researchers, this may include some fairly sophisticated statistical techniques. For most clinical service providers and supervisors, however, the implications are far less daunting, focusing primarily on where to find evidence, and how to be discriminating consumers of evidence, whether of a journal article, an ASHA Convention session, a continuing education offering, or an item in the popular press.
One important aspect of assessing evidence is the consistent use of a scheme of levels of evidence. Levels of evidence in this context refers to a hierarchy of research—based on study design and study quality—arranged according to the relative "strength" of the research as a basis for decision-making. Members of the ACEBP are currently adapting one of the most widely-used hierarchies from Oxford University's Center for Evidence-Based Medicine to make it applicable to speech, language, and hearing research.
One of the most important roles to be played by N-CEP is to provide ongoing support for members in identifying and/or assessing the evidence that will help them make the best clinical decisions. Extensive use will be made of ASHA's Web site, the EBP section (members only) of which already contains educational information and links to other resources such as Web-based tutorials and training opportunities.
In order to determine what areas of support would be most helpful to ASHA members, a knowledge-attitude-practices survey was conducted in May. The survey results indicated that time was the single most common barrier to EBP cited by respondents. Seventy-seven percent of clinical service providers cited "insufficient time" as either a major or moderate barrier to their ability to engage in EBP.
Given this finding, N-CEP and other ASHA staff are looking at ways to limit the amount of time needed to find and assess relevant evidence. As one example, N-CEP is currently developing a registry of clinical practice guidelines meeting internationally accepted standards for evidence-based guidelines. Upon completion later this year, the registry will reside on the ASHA Web site and will be fully searchable.
Although other guideline registries exist, none are specific to communication disorders, and most make no attempt to limit the guidelines only to those judged to meet external standards of quality. Moreover, ASHA members will also be able to call upon N-CEP's Reference Librarian for guidance in identifying sources of evidence, and other N-CEP staff for assistance in critically assessing evidence. Tools such as these will provide clinicians with various short-cuts to vital information that is readily available to inform their practice.
Another frequently-cited barrier to EBP was the evidence base itself. Sixty-three percent of all survey respondents cited the evidence (either that it was non-existent, conflicting, or irrelevant to their particular patients) as a major or moderate barrier. Synthesis of the existing evidence, and assessment of it with a consistent, scientifically-accepted, and transparent methodology are necessary for a shared understanding (both within ASHA and among external stakeholders such as payers and policymakers) of the extent to which the care provided by SLPs and audiologists is based on sound scientific evidence.
Many members will be surprised by how much evidence actually exists on some topics, and how little exists on others. Synthesis of the evidence into evidence-based systematic reviews and ultimately into EBP guidelines also addresses the time barrier, as these reviews and guidelines will provide a much quicker alternative to an individual clinician undertaking an exhaustive search and review of the literature.
As the demands for EBP increase, ASHA is taking steps to ensure that members are armed with the knowledge, tools, and support they need to succeed and encourages frequent visits to the EBP section (members only) for the latest available information.