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ISIC Conference, Vilnius, 2008 - Abstracts from the Doctoral Workshop

Exploring rehabilitation therapists' clinical questions for evidence based patient care

Lorie Andrea Kloda
McGill University School of Information Studies, McLennan Library Building, 3459 McTavish Street Montreal, Quebec H3A 1Y1, Canada

Introduction

Evidence based practice has emerged as an influential paradigm for health care practitioners, beginning with physicians before proceeding to nurses and allied health professionals. In the 21st century, health information is abundant, and the challenge is no longer to find or access information, but to locate and make use of good quality information, or evidence, in order to deliver the best possible health care. In information studies, the information behaviour of health professionals (physicians and nurses) and allied health professionals can be studied to better understand what information these clinicians need, how they seek and how they use information to inform practice.

Rehabilitation therapists, including occupational therapists, physiotherapists, and speech-language pathologists, play an essential role in health care. Even so, their information behaviour is overlooked in the literature in information studies. The information behaviour of health professionals such as physicians and nurses is better understood as a result of studies on their information needs, information seeking behaviour and information use.

In order to improve the training and informational services to rehabilitation therapists for supporting evidence based practice, their information behaviour, particularly their information needs, require identification and explanation. This study explores the information needs of rehabilitation therapists that arise during the patient encounter, that is, their clinical questions, as a preliminary step in understanding rehabilitation therapists' information behaviour and how it compares to that of health professionals.

Clinical questions are the formalized information needs arising from patient care. Taylor's (1968) typology of information needs, which is the most often cited in the literature (Case 2007), includes four types of information needs, or questions:

Q1. Visceral need (unexpressed)
Q2. Conscious need (acknowledge, in the brain)
Q3. Formalized need (expressed, formal statement)
Q4. Compromised need (input into the system)

The formalized need (Q3) is the type of information need that this research study is concerned with. According to Taylor, "at this level an inquirer can form a qualified and rational statement of his question. Here he is describing his area of doubt in concrete terms and he may or may not be thinking within the contexts or constraints of the system from which he wants information" (Taylor 1968: 182). In the context of patient care, this formalized information need is called a clinical question. Note that a clinical question need not be in the form of an interrogative statement (i.e., ending with a question mark), but may take the form of a declarative statement. It must, however, indicate a gap in information related to patient care.

Research problem

Rehabilitation therapists form a significant proportion of allied health professionals, and are central to health care delivery. As practitioners, rehabilitation therapists engage in information behaviour: they identify information needs, decide whether or not to seek answers to these needs, engage in seeking behaviour, and then decide on how to use the information to improve patient care. Even so, rehabilitation therapists are neglected in the literature on information behaviour. Little is known about the information needs that arise in rehabilitation therapists' day-to-day practice and how they cope with these needs through information seeking and use.

In her review of information seeking behaviour, Marshall (1993) remarked that there was very little research on professionals others than physicians, and this proportion remains relatively constant to the present day. While several studies purport to describe the information behaviour of rehabilitation therapists, none of these were conducted by information studies researchers in the context of information behaviour theory. Information seeking is but one aspect of information behaviour research, along with needs and use. Few studies report on the actual information needs of rehabilitation therapists in any depth.

At the same time, the evidence based practice framework is being encouraged in the field of rehabilitation (Bury and Mead 1998; Plastow 2006; Reilly et al. 2004; Taylor 2000), and rehabilitation therapists are expected to be skilled at asking clinical questions, retrieving relevant evidence, and appraising and applying the evidence to their practice (American Physical Therapy Association 2005; Canadian Association of Occupational Therapists 2008 and Robey et al. 2004).

There is much evidence to inform rehabilitation therapists' clinical practice, but research suggests that is often not used (Dysart and Tomlin 2002; Jette et al. 2003; Sweetland and Craik 2001; Turner and Whitfield 1997). That is, despite efforts to teach and promote evidence based practice, it is not being implemented by rehabilitation therapists. Various obstacles have been identified that inhibit the implementation of evidence based practice in rehabilitation (Humphris et al. 2000; Pollock et al. 2000), including rehabilitation therapists' difficulty in formulating clinical questions (Bennett et al. 2003). In the past few years, new databases have emerged to support evidence based practice for rehabilitation, including PEDro (Sherrington et al. 2000), OTseeker (McKenna et al. 2004), and Hooked on Evidence (Scalzitti 2003). These databases assume that users have specific clinical questions, and that they possess the required search skills to locate the evidence. User studies on these databases demonstrate that this is not the case, as search terms entered are often vague (Bennett et al. 2006). Research is needed to identify what clinical questions rehabilitation therapists ask, and if these are in fact conducive to evidence based practice.

Purpose and objectives

This study links the information needs of rehabilitation therapists to the activity of patient care, and is therefore a study of the person-in-context, or of rehabilitation therapists as providers of patient care. Patient care is one of several roles undertaken by rehabilitation therapists in which individualized attention and decision making takes place to inform and improve the patient's condition.

The purpose of this research is to explore rehabilitation therapists' clinical questions for evidence based patient care. The research can be broken down into several narrower objectives:

To identify clinical questions which arise during and after the patient encounter;
To examine clinical questions for common elements or patterns, such as those suggested by the evidence based practice framework;
To categorize clinical questions;
To discover why some clinical questions are pursued while others are not.

Methodology and method

The objectives of this research are best understood within the philosophical tradition of interpretive or qualitative research. Using purposive sampling, clinical questions will be sought from between 10 to 15 informants working in a rehabilitation centre serving patients with stroke. For this research, it is expected that approximately 100 clinical questions will be collected in total. These clinical questions arising from patient encounters will be recorded by informants using a structured journal over the course of one or two weeks. The clinical questions from each informant will be analyzed before being supplemented a semi-structured interview to clarify the clinical questions and explore other aspects of the research objectives.

Progress to date

The doctoral research project is currently at the proposal writing stage, with the methods of data collection and analysis being refined. Once the proposal is successfully defended, in early 2009, data collection will begin.

Acknowledgements

This research is supported in part by the Thomson Scientific / Medical Library Association Doctoral Fellowship, the Canadian Library Association World Book Graduate Scholarship, and the Doctoral Research Scholarship from the Fonds québécois de la recherche sur la société et la culture.

References

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