Decision making and the use of evidence-based practice: Is the three-legged stool balanced?

Abstract

This article presents the results of a qualitative analysis of interviews with 25 psychologists in independent practice, with a focus on decision making with a selected patient. We endeavored to examine how clinical decision making intersected with the principles of evidence based practice (EBP) as laid out by Spring (2007). Clinicians reported that diagnostic impressions were generally formulated through unstructured assessment rather than validated instruments, and that treatment selection was based on therapists' perceptions of a treatment's match with client characteristics. Therapists viewed CBTs as appropriate for addressing symptoms but believed they needed to depart from CBT strategies to address underlying issues. Nonetheless, they often defined successes and failures in treatment in terms of symptoms. Overall, clinicians rarely mentioned utilization of research evidence for assessment or treatment selection and practice. Results are discussed within the framework of EBP. Clinical Impact StatementIn a small qualitative study of decision-making in psychologists in independent practice, researchers found that: (1) Diagnostic impressions are generally formulated through unstructured assessment rather than validated instruments, (2) Clinicians largely reported selecting treatment based on a perceived match with patient characteristics and (3) Many clinicians described a treatment decision process in which they used structured (cognitive-behavioral) approaches to deal with symptoms and insight-oriented modalities (psychodynamic or interpersonal) to work on personality processes. Additional effort may be necessary to make evidence-based practice and decision-making more appealing, practical and relevant for clinicians and clinical practice.

Use of Human-Centered Design to Improve Implementation of Evidence-Based Psychotherapies in Low-Resource Communities: Protocol for Studies Applying a Framework to Assess Usability

“…EBPI implementation is particularly challenging because most people receive treatment for mental illness in nontraditional or integrated settings such as primary care [12] and schools [13,14]. EBPIs were typically not developed for these settings, resulting in poor contextual fit and low adoption [15,16]. To address EBPI implementation barriers, decades of research has focused on provider, patient, setting, and policy barriers [17], yet actionable and cost-efficient solutions remain elusive [18].…”

Evidence-Based Practice in Mission: A Method for Establishing Best Practices and Achieving Desired Goals

“…Research conducted among twenty-five clinical psychologists revealed that "diagnostic impressions were generally formulated through unstructured assessment rather than validated instruments, and that treatment selection was based on therapists' perceptions of a treatment's match with client characteristics." 44 Likewise, numerous studies have demonstrated that there may be an industry-wide preference for clinical expertise among clinicians when making treatment choices and discounting the contribution of other sources of evidence. 45 The same can be true in the process of making ministry decisions.…”

El Conocimiento y el Uso en la Práctica Clínica de los Tratamientos Psicológicos Basados en la Evidencia

“…Furthermore, research outcomes are mostly disseminated in scientific journals, meaning that results may not reach applied professionals (Echeburúa et al, 2010). Therefore, clinical decisions are made based on their professional experience (Gyani, Sharan, Myles, & Rose 2014; Safran et al, 2011; Stewart & Chambless, 2007;Stewart, Chambless, & Stirman, 2018;Stewart et al, 2012). Likewise, prior studies have revealed that personal factors such as age, therapeutic orientation, education level, years of experience, and professional context, impact on the use of EBTs.…”

“…El hecho de que los resultados de la investigación se divulguen mayoritariamente en revistas científicas puede ocasionar que dichos resultados no lleguen a los profesionales aplicados (Echeburúa et al, 2010). Varias encuestas han demostrado que pocos profesionales de la psicología clínica leen revistas científicas (Safran, Abreu, Ogilvie y DeMaria, 2011;Stewart y Chambless, 2007), tomando las decisiones de tratamiento en base a su experiencia clínica o a la de sus compañeros (Gyani, Shafran, Myles, y Rose 2014;Safran et al, 2011;Stewart y Chambless, 2007;Stewart, Chambless y Stirman, 2018;Stewart et al, 2012). Además, algunos estudios han señalado que factores personales como la edad del profesional (Aarons y Sawizky, 2006), la orientación terapéutica (Gyani et al, 2014;Safran et al, 2011;Stewart y Chambless, 2007), el nivel educativo (Beidas y Kendall, 2010), los años de experiencia clínica (Beidas y Kendall, 2010) y el ámbito laboral (Gyani et al, 2014) pueden influir en el uso de los TBE.…”