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Evidence-Based Practice: A Process for Practical Implementation. Leonard Gibbs, University of Wisconsin—Eau Claire & Stanley McCracken, University of Chicago. Agenda.

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Evidence based practice a process for practical implementation

Evidence-Based Practice: A Process for Practical Implementation

Leonard Gibbs, University of Wisconsin—Eau Claire & Stanley McCracken, University of Chicago

Agenda Implementation

  • 9:00 – 10:00 Our Mission, Facts Regarding Emergence of EBP Now, Definitions of EBP by Concept, Operation, EBP Team Skills Example (DVD)

  • 10:00 – 10:30 Four Elements of Well-Built COPES Questions and Six Types

  • 10:30—10:40 Importance of Posing Well-Built Questions, First Group Exercise

  • 10:40-10:50 A Single Case Applying One COPES Question and Worksheets Demonstrating the EBP Process

Agenda Implementation

  • 10:50-11:30 Group Exercises Posing Well-Built COPES Questions (We circulate to help groups.)

  • 11:30-11:50 Search Techniques to Demonstrate the Following: Search Planning, Appropriate MOLES, Boolean Logic, Appropriate Databases, Search History, Criteria for Rating Evidence

  • 11:50-12:00 Len’s Website

  • 12:00-1:00 (Sharp) Lunch Individuals in Groups Practice Posing Their Own Well-Built Questions (each person bringing one question back from lunch)

Agenda after lunch
Agenda After Lunch Implementation

  • 1:00-1:30 Some Morning’s Questions Searched, Critical Appraisal Skills Program and Len’s Evidence Rating Forms; Participants Read Their COPES Questions; Live Search

  • 1:30-1:50 Cheese Head Competition (For marker documents)

  • 1:50-2:50 Len & Stan & Helpers Circulate, Participants Conduct Their Own Searches (Keeping a search history for later reference)

  • 2:50-3:00 What Have We Learned?

Our mission
Our Mission Implementation

  • Help Children and Adolescents

  • Incorporate Elements of Evidence-Based Practice In the Process of Helping

The spirit of evidence based practice
The Spirit of Evidence-Based-Practice Implementation

  • Essential, Elemental, Primary Element in Evidence-Based Practice: Searching for Disconfirming Evidence With Same Determination as for Confirming Evidence.

Evidence based practice a process for practical implementation

Forces Making Evidence-Based Practice Possible Implementation

Database Availability

Study Syntheses


Internet Access and Speed

New Search Methods Based on Well-Built Questions

Internet speed
Internet Speed Implementation

  • Optical devices built on silicon chips could effortlessly transfer oversize digital files…at rates of 10 gigabits a second….” (Jalani, Feb. Issue of Scientific American, 2007, p, 59)

Database availability
Database Availability Implementation

  • ERIC

  • Cochrane Library Abstracts

  • PubMed

  • Bandolier “evidence based thinking about health care”

  • My book’s website: http://www.evidence.brookscole.com/

Study syntheses
Study Syntheses Implementation

  • Cochrane Library

  • Campbell Collaboration

New search methods and new skills
New Search Methods and New Skills Implementation

  • Critical Appraisal Skills Program (CASP) http://www.phru.nhs.uk/casp/critical_appraisal_tools.htm

  • Boolean Logic

  • Database Thesauruses

  • Methodological Filters

Newest ebp model

Clinical state and circumstances Implementation

Clinical Expertise

Client Preferences and actions



Newest EBP Model

Haynes, Devereaux, and Guyatt, 2002

Ebp is not
EBP Is Not: Implementation

  • What we have been doing all along with a new name

  • Slavish adherence to research evidence alone to direct our practice

  • A term with a universally accepted and agreed on definition

Ebp defined by concept
EBP Defined by Concept Implementation

  • Evidence-based medicine (EBM) requires the integration of the best research evidence with our clinical expertise and our patient’s unique values and circumstances (Straus, Richardson, Glasziou & Haynes, 2005, p.1)

Ebp defined by concept1
EBP Defined by Concept Implementation

  • “Placing the client’s benefits first, evidence-based practitioners adopt a process of lifelong learning that involves continually posing specific questions of direct practical importance to clients, searching objectively and efficiently for the current best evidence relative to each question, and taking appropriate action guided by evidence.” (Gibbs, 2003, p. 6)

Ebp defined by operation
EBP Defined by Operation Implementation

  • Become Motivated to Apply EBP (My Step Added)

  • Step 1—Convert information need (prevention, assessment, treatment, risk) into an answerable question.

  • Step 2—Track down the best evidence to answer the question.

  • Step 3—Critically appraise the evidence for its validity (closeness to the truth) impact (size of the effect) and applicability (usefulness in our practice).

Ebp defined by operation1
EBP Defined by Operation Implementation

  • Step 4—Integrate critical appraisal with our practice experience, client’s strengths, values circumstances.

  • Step 5—Evaluate effectiveness and efficiency in exercising steps 1-4 and seek ways to improve them next time.

  • Step 6—Teach others to follow the same process (based on Sackett et al., 2000)

Definition by example interdisciplinary ebp team skills
Definition by Example: Implementation Interdisciplinary EBP Team Skills

  • General Question Posed

  • Client Oriented Practical Evidence Search Question (COPES)

  • Search Planning

  • Handling Problems (with searching)

  • Appraising the Evidence

  • Drawing Conclusions Based on Evidence

What little we know about interdisciplinary ebp team skills
What Little We Know About Interdisciplinary EBP Team Skills Implementation

  • Aron Shlonsky & Michael Saini, University of Toronto, EBP within an Interdisciplinary / Multidisciplinary Team Context: An analysis of peer-reviewed publications

    • Searched In Published and Gray Literature Finding 2045 abstracts

    • Applying the Criteria on the Next Slide

Shlonsky and sinai s inclusion criteria
Shlonsky and Sinai’s Inclusion Criteria Implementation

1) Use of Multidisciplinary / Interdisciplinary / Cross disciplinary / Transdisciplinary / Interprofessional team: Yes / No

2) Study on an individual or group: Yes / No

3) There is some evidence that the author(s) used an Evidence Based Practice Process at the individual client/patient level:

  • Problem Identification: Converting information needs into an answerable question: Yes / No

  • Evidence Search: Finding, with maximum efficiency, the best evidence with which to answer the question: Yes / No

  • Critique: Determining the merit, feasibility and utility of evidence: Yes / No

  • Synthesis: Combining findings from all evidence to make a practice recommendation: Yes / No

Finding regarding effectiveness of interdisciplinary ebp teams one article so far
Finding Regarding Effectiveness of Interdisciplinary EBP Teams: One Article, So Far:

Akobeng, A. K. (2005). Evidence in practice. Archives of Disease in Childhood, 90(8), 849-852.

Importance of posing well built questions
Importance of Posing Well-Built Questions Teams: One Article, So Far:

Ebp defined by example situation
EBP Defined by Example: Teams: One Article, So Far: Situation

A 60 year old white male is in his doctor’s office reviewing laboratory test results with his doctor. The patient’s grandfather died of prostate cancer; his mother died of breast cancer; his father died of esophageal cancer, and his sister has breast cancer. His doctor says: “Your PSA is up a bit (.8 to 1.9 in 20 months), but we will have to watch it.”

Ebp defined by example posing a well built question
EBP Defined by Example: Posing a Well-Built Question Teams: One Article, So Far:

Question: For a sixty year old with a family history of cancer, with a PSA of .8 moving to 1.9 in 20 months, what is the probability that he has prostate cancer?

You can find out the probability at this website
You can find out the probability at this website: Teams: One Article, So Far:

  • Enter into Google this phrase: evidence-based practice as if you life depended on it.

  • http://www.uwec.edu/lgibbs/index.htm

One real example regarding a case showing use of handouts
One Real Example Regarding a Case Showing Use of Handouts Teams: One Article, So Far:

  • Child Sex Abuse Case

  • Search Plan Related to the Case

  • Search History Related to the Case

Copes questions
COPES Questions Teams: One Article, So Far:

  • Client-Oriented

  • Practical

  • Evidence-Search

    Gibbs, L. E. (2003). Evidence-based practice for the helping professions: A practical guide with integrated multimedia. Pacific Grove, CA: Brooks/Cole.

Research question copes question
Research Question COPES Question Teams: One Article, So Far:

Formulating effectiveness prevention questions
Formulating Effectiveness/ Teams: One Article, So Far:Prevention Questions:

a)Comparing an intervention to no intervention

b) Comparing two interventions

c) What is the best intervention?

Formulating assessment risk questions
Formulating Assessment/Risk Questions: Teams: One Article, So Far:

a) Comparing an assessment instrument/ procedure to no assessment

b) Comparing two assessment instruments/ procedures

c) What is the best assessment instrument/ procedure?

Formulating descriptive quantitative questions
Formulating Descriptive (Quantitative) Questions: Teams: One Article, So Far:

a) Summarizing characteristics (how much, how many, what percentage, what is the average?)

b) Asking about relationships between variables

Formulating descriptive qualitative questions
Formulating Descriptive (Qualitative) Questions: Teams: One Article, So Far:

a) Require narrative responses

b) Suggest in-depth explorations, little known phenomena (how would they describe, what is the process, how do they experience?)

Evidence based practice a process for practical implementation

This format from Gibbs (2003) follows Sackett, D. L., Richardson, W. S., Rosenberg, W. & Haynes, R. B.(1997). Evidence-based medicine: How to practice and teach EBM. New York: Churchill Livingstone.

Practice posing copes questions
Practice Posing COPES Questions Richardson, W. S., Rosenberg, W. & Haynes, R. B.(1997).

  • You need:

    • Sheet marked “Five types of questions typically emerge in practice”

    • Sheet with “Example ADHD Q.” in upper left corner

    • Clinical Scenarios for Question Posing Exercises

    • Three teammates to practice posing questions

Search techniques
Search Techniques Richardson, W. S., Rosenberg, W. & Haynes, R. B.(1997).