Deciding to pursue answers to clinical questions: An exploratory study of stroke clinicians
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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
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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
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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)
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Sampling & recruitment
Stroke rehabilitation
Purposeful, snowball sampling
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Methods
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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
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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
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Implications
EBP and information literacy instruction
Clinical information services
EBP framework
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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