Lesson 5: Evidence-Based Practice in the Substance Use Workforce—Developing Skills for Finding the Best Evidence

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This lesson is intended to develop your knowledge of the principles of evidence-based practice (EBP) and the skills used to ask good clinical questions for finding or searching for the best evidence. The next lesson will focus on applying these principles in practice.

As you read the literature associated with evidence-based practice, you will find terminology that is used interchangeably. In addition to the EBP and evidence-based decision making (EBDM) that we are using in this course, you will encounter terms such as evidence-informed practice, evidence-guided practice (Gitterman & Knight, 2013), and evidence-based medicine. Fundamentally, all these terms stand for the same principles and practices, so you can choose the term that fits best with your context. We are using the more generic terminology, since it is better suited to inter-professional practice.

EBP is not a new concept, although it has been receiving increased attention over the last two decades. EBDM is the process that one undertakes to conduct EBP. Based on Sackett, Richardson, Rosenburg, & Hayne’s work, evidence-based decision-making has been defined as “the integration of the best research evidence with clinical expertise and patient values” (cited in Glasner-Edwards & Rawson, 2010). In this model, scientific evidence alone is not a sufficient condition to make a decision about a particular intervention. Similarly, your experience and judgement alone are not sufficient; nor are the client’s wishes adequate as the sole decision making factor. EBDM is based on the integration of scientific knowledge; your experience and judgment; and the client’s preferences, values, and circumstances. Simply put, EBP helps clinicians to collect and critically appraise the best evidence (from literature, self, and client) for the purpose of guiding an intervention or treatment decision (Murphy, 2012).

Note that in the model depicted in Forrest & Miller (2009), patient preferences and values have been separated from the clinical/patient circumstances. Similar to the interchangeability of the terminology of evidence-based practice, you will find adaptations of this model. Once again for the purposes of an introduction, we will treat the fundamental principles the same while recognizing that one model or another may be more appropriate for your profession. For example, in social work, this model is adapted to recognize that everything—including research knowledge, practitioner expertise, and client preferences—is informed by, and responsive to, the overall organizational, cultural, and environmental circumstances.

diagram illustrating elements of Evidence-Based Behavioral Practice
Figure 1: Evidence-Based Behavioural Practice. Spring, B. & Hitchcock, K. (2009). Evidence-based practice in psychology. In I.B. Weiner & W.E. Craighead (Eds.) Corsini’s Encyclopedia of Psychology, 4th edition (pp. 603-607). New York: Wiley.

The process of EBDM defines a set of skills required to apply EBP. These skills begin with the formulation of a focused researchable question, finding the best external “evidence” to answer the question, and then critically appraising that evidence for its validity and usefulness (Forrest & Miller, 2009). This lesson focuses on the first two components of EBDM. In lesson 6, the skills used to appraise and apply the evidence will be used to consider a practice situation, and Assignment 2 (due at end of lesson 6) will provide an opportunity for you to apply the model to a situation relevant to your practice.

As with the first part of this course, these readings and skills continue to be linked to the Canadian Centre on Substance Abuse (CCSA) competency standards, and in Activity 2, you will be asked to explicitly make those linkages.

Topics

Lesson 5 addresses the following topics:

  • Evidence-based practice: An introduction to the principles
  • Evidence-based practice: CCSA competencies
  • Evidence-based practice: Asking good questions and seeking the evidence

Learning Outcomes

After you complete this lesson, you should be able to:

  • Explain the principles of EBP.
  • Examine the skills required for applying the principles of EBP.
  • Assess how competency in EBP supports achieving competency in the prescribed attributes of Canada’s Substance Abuse Workforce.
  • Demonstrate competence in the evidence-based decision making process.
  • Create searchable clinical questions.
  • Perform a basic systematic literature search.

Resources

Murphy, M., MacCarthy, M.J., McAllister, L., & Gilbert, R. (2014). Application of the principles of evidence-based practice in decision making among senior management in Nova Scotia’s addiction services agencies. Substance Abuse Treatment, Prevention, and Policy, 9, 47.

Web Links

Canadian Institutes of Health Research (CIHR) website

Centre for Evidence-Based Medicine website or access the EBM resources directly at: http://www.cebm.net/category/ebm-resources/

Available Through TRU Library

Fineout-Overholt, E., & Johnston, L. (2005). Teaching EBP: Asking searchable, answerable clinical questions. Worldviews on Evidence-Based Nursing, 2, 157–160.

Fineout-Overholt, E. Hofstetter, S., Shell, L., Johnston, L. (2005). Teaching EBP: Getting to the gold—How to search for the best evidence. Worldviews on Evidence-Based Nursing, 2(4), 207–211.

Forrest, J., & Miller, S., (2009). Translating evidence-based decision making into practice: EBDM concepts and finding the evidence. The Journal of Evidence-Based Dental Practice, 9(2), 59–72.

Glasner-Edwards, S., & Rawson, R. (2010). Evidence-based practices in addiction treatment: Review and recommendations for public policy. Health Policy, 97(2–3), 93–104.

Miller, S., & Forrest, J., (2009) Translating evidence-based decision making into practice: Appraising and applying the evidence. The Journal of Evidence-Based Dental Practice, 9(4), 164–182.

Activity Checklist

Following is a checklist of the learning activities you will be completing in Lesson 5. You may find it useful for planning your work.

✔ Activity

☐ Activity 1: Evidence-based practice—An introduction

☐ Activity 2: Evidence-based practice and CCCSA competency standards

☐ Activity 3: ASK—Developing a searchable question

☐ Activity 4: ACQUIRE—Finding the evidence