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Response to Re: The evidence in evidence‐based practice. Why the confusion?

EDITOR: In stating the case for a specific use of the term ‘evidence’ in evidencebased practice (EBP) to mean external research evidence, I suggested that to do otherwise is potentially confusing and that confusion could be one explanation for the slow uptake of evidence-based practice by optometrists. The specific use of the term ‘evidence’ is consistent with the various definitions and interpretations of evidencebased practice but not all, as I explain further in this letter. As I acknowledged in my original article, it is also important to recognise that other sources of information contribute to clinical expertise (in its widest interpretation) and inform clinical decisionmaking; however, many of these sources of information, such as undergraduate training, do not need to be, nor should be, called evidence. To suggest that they can be viewed as evidence simply because they form the basis of a clinical decision is to semantically broaden evidence to mean information and EBP to mean clinical practice. The use of the term ‘evidence’ in evidence-based practice to mean research evidence does not exclude other sources of information used in the clinical decision-making process and simply avoids the peripheral arguments as to the nature of evidence, which seem driven by a particular political agenda outside of optometry. Indeed the following comments by Hoffmann, Bennett and Del Mar, which can be misquoted in support of the broader use of the term ‘evidence’, are enlightening. “Many authors have debated the nature of ‘evidence’, arguing that evidence comes from many sources other than research. While it is vital to incorporate information from many different sources, the term ‘evidence’ in evidence-based practice serves a specific purpose. Its purpose is to highlight the value of information from research which has so often been ignored. In fact, some have suggested that, instead of the term evidence-based practice, ‘knowledgebased practice’ or ‘information-based practice’ should be used. While these alternatives avoid the contentiousness about what evidence is and what it is not it would be impossible to find a health professional who does not base their practice on knowledge or information. In other words, use of the term ‘evidence’ (where evidence is taken to mean evidence from research) helps to highlight a source of information that has been under utilised. Use of the term ‘evidence’ to highlight the role of research in clinical decision making by no means discounts the importance of information and knowledge from clients and health professionals themselves . . .”. A number of alternative explanations for the slow uptake in evidence-based practice by optometry can be posited: optometrists do not enjoy ready access to the research literature, optometrists do not have the time or the skills to critically appraise the literature, optometrists prefer to receive information from an authority rather than sourcing and assessing the material independently and possibly others. Regardless of the cause(s), there is a clear need to address this issue and the evidence-based optometry project (www. evidencebasedoptometry.unsw.edu.au) is an important initiative, appropriately targeted at those currently in training who will become the next generation of practitioners. I remain concerned that the project offers little more to those already in practice, based on the interpretation of the responses to the survey by Suttle, Jalbert and Alnahedh and in recognition of existing access to various online evidence-based practice resources such as the Cochrane Library (http://www.thecochranelibrary. com). In setting out my views on what I put forward as an apparent reluctance by some optometrists to embrace evidencebased practice, I set out to be disruptive, not so much argumentative for no other purpose, although there is much to be said for a well played out argument but to spark debate as to the nature of evidencebased practice in the optometric setting and what can be done to facilitate its uptake. It was triggered, in part, by the earlier work of Suttle, Jalbert and Alnahedh and I am delighted that they have commented on the views expressed in my article and hope that the discussion is of interest to a wider audience across the profession.