Research evidence is one of the pillars of EBP. Despite problems with the nature and use of such evidence, it has a positive contribution to make to clinical practice as it provides for a scientific touchstone. However, it may be that the speech and language therapist and not the research evidence is the primary pivot upon which scientific practice is based.

Background: Oropharyngeal dysphagia post-stroke is well known, with its presence increasing the risk of poor outcomes in particular aspiration and aspiration pneumonia. Management to minimize the risk of aspiration and improve swallow safety post-stroke includes the treatment of thickened liquids (TL), an established bolus modification intervention. Despite widespread use, there is a lack of robust empirical evidence and minimal patient evidence as to the experience and acceptability of using thickeners by people who experience dysphagia after a stroke. Aims: To explore people with swallowing disorders post-stroke experiences of and acceptability regarding the bolus modification treatment of thickened liquids. Methods & Procedures:A qualitative, descriptive study exploring the experiences of individuals given TL after their stroke. A purposive sample of 14 adults was obtained with data collection and generation through the medium of individual semi-structured interviews. Inductive thematic analysis was used to analyse the data. Outcomes & Results: Three overarching themes of 'uncertainty', 'an unpleasant experience' and 'a trade-off' were identified. These themes highlight that participants disliked TL and this dislike may have impacted clinically in terms of adherence, hydration and quality of life. Lack of sensory appeal was important in framing patient dislike. Participants' involvement in and understanding of reasons for prescription of TL was poor leading to uncertainty regarding the treatment. Notwithstanding, some participants felt it was necessary for their stroke recovery. Conclusions & Implications: TL can be considered a burdensome treatment from multiple perspectives including product palatability, treatment uncertainty and treatment adherence issues. Despite intensely disliking this treatment, some patients ultimately understand why the treatment is prescribed. Improvements in product palatability are required in order to improve adherence and patient quality of life. Consideration of other treatment options and newer products to manage aspiration post-stroke is also warranted.

Introduction Research findings consistently suggest that speech and language therapists (SLTs) are failing to draw effectively on research-based evidence to guide clinical practice. Such decision-making is one of the least visible aspects of practice. This study aimed to examine what constitutes the reasoning provided by SLTs for treatment choices and whether science plays a part in those decisions. Method This study, based in Ireland, reports on the qualitative phase of a mixed methods study which examined attitudes underpinning treatment choices and the therapy process. SLTs were recruited from community, hospital, and disability work settings via SLT mangers who acted as gatekeepers. A total of three focus groups were run. Questions were developed based on the original research aims and from the four key domains -client suitability, clinical experience, training and the role of science --generated from survey data from a previous phase.. Data were transcribed, anonymised and analysed using thematic analysis. Results In total,48 participants took part in the focus groups. The majority of participants were female, represented senior grades and had basic professional qualifications. Three key themes were identified: practice imperfect; practice as grounded and growing; and critical practice. Findings show that treatment decisions are 'scaffolded', primarily on practiceevidence. This practice-evidence is both routine and evolving and decisions are both habitual and engaged. The uniqueness of each patient results in dynamic and pragmatic practice, constraining the application of unmodified therapies. Conclusion The findings reflect the complexities and paradoxes of clinical practice as described by SLTs. Practice is pivoted on both the patient and clinician, through their membership of groups and as individuals. The findings suggest that scientific thinking is a component of decision-making; a tool with which to approach the various ingredients and the dynamic nature of clinical practice. However, these scientific elements do not necessarily reflect EBP as typically constructed.

BackgroundPatient decision aids (DAs) are support tools designed to provide patients with relevant information to help them make informed decisions about their healthcare. While DAs can be effective in improving patient knowledge and decision quality, it is unknown what types of information and evidence are used to populate such decision tools.MethodsSystematic methods were used to identify and appraise the relevant literature and patient DAs published between 2006 and 2015. Six databases (Academic Search Complete, AMED, CINAHL, Biomedical Reference Collection, General Sciences and MEDLINE) and reference list searching were used. Articles evaluating the effectiveness of the DAs were appraised using the Cochrane Risk of Bias tool. The content, quality and sources of evidence in the decision aids were evaluated using the IPDASi-SF and a novel classification system. Findings were synthesised and a narrative analysis was performed on the results.ResultsThirteen studies representing ten DAs met the inclusion criteria. The IPDASI-SF score ranged from 9 to 16 indicating many of the studies met the majority of quality criteria. Sources of evidence were described but reports were sometimes generic or missing important information. The majority of DAs incorporated high quality research evidence including systematic reviews and meta-analyses. Patient and practice evidence was less commonly employed, with only a third of included DAs using these to populate decision aid content. The quality of practice and patient evidence ranged from high to low. Contextual factors were addressed across all DAs to varying degrees and covered a range of factors.ConclusionsThis is an initial study examining the information and evidence used to populate DAs. While research evidence and contextual factors are well represented in included DAs, consideration should be given to incorporating high quality information representing all four pillars of evidence based practice when developing DAs. Further, patient and expert practice evidence should be acquired rigorously and DAs should report the means by which such evidence is obtained with citations clearly provided.Electronic supplementary materialThe online version of this article (doi:10.1186/s12911-017-0415-7) contains supplementary material, which is available to authorized users.

Factors influencing decision making did not clearly align with the four pillars of EBP, the principal influences being practice evidence and pragmatic constraints. The findings of this study have implications for understanding why specific treatment choices are made. Attempts to improve practice should focus on a range of evidence sources and take into account clinician's specific needs depending on career stage, post-qualification status and patient group factors of their practice.