3. Individualised application of the evidence into practice
3.2. Sharing evidence with your clients
3.2 Sharing evidence with your clients
After acquiring as much information as possible, the clinician is required to discuss their decision-making with the relevant parties, such as the client and relevant colleagues.
Shared decision-making (SDM) is receiving more attention in EBM and EBVM; the British Medical Journal included SDM as one its six proposals for EBM’s future in their online EBM toolkit .
There are a number of ways to share and discuss evidence with your clients through verbal and written communication channels.
Owners may be wary of new treatments or different approaches, particularly if they have had previous success through other treatment approaches, so it will be of benefit to spend time discussing any new evidence with them. Discussing evidence with clients will potentially improve uptake of the new approach and owner compliance in seeing it through.
Electronic and/or paper copies of journal articles
For clients who have some medical or scientific background, providing electronic and/or hard copies of open access literature relevant to the discussion can add to your credibility on the subject and provide convincing data to the clients.
Many practices are producing their own client leaflets to educate owners. Investigate the resources available to you in your practice. Maybe you could develop them?
Click to expand and read the scenario-based examples below.
You visit a farm with a scouring calf. You have recently read a BestBET which has the clinical bottom line:
Feeding milk in addition to an oral rehydration solution may help scouring calves to maintain or even gain weight when compared with feeding oral rehydration solution alone. Read the full BestBET
You discuss this with the farmer, who usually withholds milk from scouring calves. During the discussion you determine the reasons why the farmer withholds milk and what that approach is based on. The discussion helps you to understand why the farmer may be reluctant to change and enables you to make a good case for adopting the recommendations of the new evidence. As a result, you decide together that you will trial the combination of milk and oral fluids.
Mrs. Lee has been using a glucosamine supplement for the last two years with the aim of reducing the clinical signs of osteoarthritis in her pet dog, Barney. You read a BestBET and a ‘What is the Evidence?’ publication in the Journal of the American Veterinary Medical Association outlining that this supplement may not be effective. Mrs. Lee has been using the product for some time and is convinced that there are some benefits gained by using it, although she still feels that Barney is reluctant to walk as far.
You take time to discuss with Mrs Lee the benefits of other therapies (such as carprofen or other NSAIDs) for reducing the clinical signs of osteoarthritis which have been recognised in research studies. During the discussion, you provide her with the opportunity to ask questions about the expectations of the treatment, the financial implications and any potential risks for her pet dog. You also find out what outcome is important to Mrs Lee from treating her dog; she reveals that she misses their daily walks to the park now he can’t walk as far and this is causing her some loneliness.
You think NSAIDs could manage Barney’s pain better and enable him to walk to the park again. You are prudent to guide the process and expectations of the treatment change. You develop a structured treatment regime in conjunction with Mrs. Lee, based on high-quality evidence, to implement treatment with NSAIDs, stopping the glucosamine, for a “test” period. It is crucial that together, you identify re-assessment points and schedule check-ups proactively so that Mrs. Lee can provide you with feedback about the new regime and how it is performing in relation to how comfortable Barney is.