Step 4: Make Your Clinical Decision
The final step of EBP requires you to make a clinical decision. To make an evidence-based decision, clinicians must use critical judgment to evaluate the strength and methodological rigor of the evidence, interpret it in consideration of the client's concerns and preferences, and judiciously apply the evidence based on what they know about an individual client and their clinical condition or trajectory—the three components of EBP.
Although this complex and nuanced process may seem difficult, the D.E.C.I.D.E. framework can help you easily remember and implement all four steps of the EBP process and help guide you to a clinical decision.
Define your clinical question, find research evidence, and determine the validity and trustworthiness of the results. The first three steps of evidence-based practice should be completed prior to making any clinical decisions. If you have not yet completed the previous steps of EBP, see:
Extrapolate clinically applicable information from the evidence. While some results may directly align with your client and setting, often, you will need to determine if the overall results are compelling and meaningful enough to apply to your clinical situation. Sometimes there is simply a lack of evidence about your clinical question. If there's little or no evidence, your treatment isn't necessarily disqualified – it just requires careful consideration and monitoring.
A lack of evidence does not equate to evidence of no effect.
Consider your clinical expertise and the expertise of others. Use your training, knowledge, clinical experience, and understanding (e.g., your familiarity with a population or approach) when considering the evidence and making a clinical decision. Refer to the
SLP Scopes of Practice and
ASHA’s Code of Ethics, as needed.
Incorporate your client's perspectives and needs. The needs and perspectives of your client, the caregiver, and/or family should factor into assessment and intervention decisions because they can provide insight into their priorities, values, and expectations. Understanding what is important to your client can help you develop your treatment plan, increase your client's participation and engagement and ensure that the goals are meaningful—not only clinically but also personally.
Develop an assessment or treatment plan by bringing together the three components of EBP. In some clinical situations, one of the EBP components may need to be prioritized (e.g., external scientific evidence reporting harm or a client’s preference/refusal); however, all three components should be considered.
- Use your clinical expertise to determine how to implement the evidence into your assessment or intervention sessions (e.g., adapting an evidence-based treatment into an engaging and individualized activity).
- Prioritize your client's perspectives to make the sessions meaningful. Include goals that are measurable and functional.
- Consider organizational or other barriers when developing your plan (e.g., access to materials, department protocols, transportation, or feasibility of implementation).
Be transparent with your client about the treatment plan, rationale, benefits, and potential harms.
Evaluate your clinical decision. Use a trial period and clinical data to ensure that the intervention is appropriate or to adjust your treatment plan as needed. EBP is a dynamic process and requires ongoing evaluation. If you don't see progress, if your client's needs or circumstances have changed, or if you need to reprioritize the goals, you should cycle through the EBP process again to find another option that can better serve your client.
Previous: Step 3–Assess the Evidence |
Return to Evidence-Based Practice