Deciding to pursue answers to clinical questions an exploratory study of

stroke clinicians

Lorie A. Kloda, MLIS, PhD, AHIPJoan C. Bartlett, MLS, PhD

McGill University

Canadian Health Libraries AssociationJune 14, 2012, Hamilton

Research objective

To explore the clinical questions of rehabilitation therapists

in the context of their everyday practice

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Information behaviour

(Wilson, 1997, p. 569)

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Information behaviour

Information need

Person-in-context

Enablers/obstaclesInformation

seeking

Information processing and use

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Information behaviour

Information need

Person-in-context

Enablers/obstaclesInformation

seeking

Information processing and use

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Evidence-based practice

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Evidence-based practice

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Clinical question

A formalized information need related to the care of a patient.

From Taylor’s (1968) typology of information needs or questions:

Q1. Visceral need

Q2. Conscious need

Q3. Formalized need

Q4. Compromised need

Research question

How do rehabilitation therapists choose which clinical questions

to pursue?

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Rehabilitation therapist

A certified professional whose aim is to improve the functional independence of individuals with

physical or cognitive disabilities.

Physiotherapist (PT) Occupational therapist (OT) Speech-language pathologist (SLP)

Sampling & recruitment

Stroke rehabilitation

Purposeful, snowball sampling

Methods

Informants

4 Occupational therapists4 Physical therapists

+ 7 Speech-language pathologists________

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Clinical questions pursued

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Findings

MemoryBelief in existence of an answer

Use of answerFeeling of responsibility

Effort requiredSelf-efficacy

Organizational support

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Memory

“I forget about it. Time goes and I have other projects and there’s other patients and because it’s busy, I just tend to drop this as the first thing to do.” (OT2)

“Honestly, time and I forget, you know.” (PT4)

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Belief or doubt in existence of an answer

”Well I, you know, I have great faith that every time I go to research something that there’s just so much information that I know that there is unbelievable amounts of information. I have faith that I will be able to answer, that I will find the information. But it’s not easy, you know.” (SLP2)

“I don't think that's likely to be answerable because it's a combination of things and usually that’s exclusion criteria in all the studies.” (PT1)

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Intended use of the answer

Advance professional knowledge or understanding

“There will probably be information about what they're doing, but I think it wouldn't vary much differently from what I'm already doing. So it might give me a few new ideas, but I don't think it would really change my practice all that much.” (PT3)

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Intended use of the answer

Establish Authority

”It would have helped. In this case, it would have helped because there was a discrepancy between what we were saying and what the family was saying.” (SLP4)

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Intended use of the answer

Decision making

Impact on patient wellbeing

Impact on future patients

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Feeling of responsibility

“At least, once I wrote it down. I’d better look for the answers.” (SLP1)

“I think it’s going to be really depressing because I’m not going to have time to answer it.” (OT2)

” really should look that up.” (SLP5)

”I’m notoriously... Bad bad therapist.” (OT4)

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Effort required to find an answer

“… you have to wade through a lot of stuff.” (SLP2)

“It’s unlikely that this is the type of question I would invest time in trying to track down an answer to, especially because it’s to the extent an answer exists, it’s likely to be in books or journals or whatever that I am not familiar with so it would be extra work for me to find it.” (SLP3)

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Self-efficacy

“That’s part of the problem because to me looking at the literature sounds like a big mountain. I don’t really know what to do although I kind of, you know, I had to do it in university but I kind of forgot. I remember the Medline and whatever but like today, if I have to go, I would be like what am I supposed to do? Where do I start? So it’s not like a fast thing because I’m not used to do it. It’s part of the problem. If it was fast, like if I knew exactly where to go and whatever, I would probably do it maybe a little bit more.” (PT4)

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Perceived organizational support

For locating evidence– Librarian– Resources (databases)– Computer access, internet access

For implementing evidence

Conclusion

Themes explain why therapists choose to pursue some clinical questions while

leaving others unanswered

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Limitations

No direct observation

Recall

Not exhaustive

Implications

EBP and information literacy instruction

Clinical information services

EBP framework

Acknowledgements

Dissertation committeeJoan Bartlett (chair), France Bouthillier,

Nicol Korner-Bitensky, Andrew Large & Pierre Pluye

Funding Thomson Scientific / MLA Doctoral Fellowship

Fonds québecois de la recherche sur la société et la culture

Canadian Library Association World Book Scholarship

Study informants

Contact

lorie.kloda@mcgill.ca

@loriekloda slideshare.net/lkloda