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200 HANDBOOK OF ELECTRONIC ASSISTIVE TECHNOLOGY

Best Research Evidence

Clinical Exper se Client / Pa ent Values
FIGURE 7-4 Evidence-based practice framework�

Evidence-Based Practice in AAC

Like other health, education and social care sectors, an everyday requirement of practitio-
ners in the AAC field is to enhance outcomes for the clients they serve, that is, to use best
evidence in decision-making. Best evidence-based practice (EBP) is commonly considered
to incorporate three key factors: (1) patient preferences/values, (2) clinical expertise, and
(3) best research evidence (Sackett et al., 1996). Working within an evidence framework
(Fig. 7-4) therefore involves the integration of current, robust, published evidence with clin-
ical expertise, and with perspectives from a broad range of stakeholders, including the AAC
user and their ‘team’. The integration of this information should lead to assessment and
intervention decisions that are effective and efficient (Schlosser and Raghavendra, 2004).

Patient Values and Preferences
Patient values may be defined in a number of ways but perhaps essentially concern ‘what
a person or group of people consider important in life’ (Friedman et al., 2006). Thus indi-
vidual values such as wishes or preferences emerge and operate within broader personal,
environmental and cultural, religious or spiritual contexts. Decision-making will, it seems,
not only need to incorporate the values of the person who may benefit from AAC support
but potentially also their carers/significant others.
Incorporating the views of people using AAC, their families, carers and support teams
demands particular interpersonal and negotiating skills from the AAC team. These skills
may need to be specifically discussed and taught to acknowledge all perspectives and bring
them together in the provision of equipment, setting communication and therapy goals
and appropriate outcome measurement. For example, how can practitioners be certain
that they are identifying authentic values in people who have communication difficul-
ties and who may also have other learning or sensory impairments? How might opposing
perspectives between the individual client and their carers and support teams be recog-
nised and engaged with, and what are the implications of this for clinical decision-mak-
ing? Should suboptimal recommendations for AAC equipment be made for an individual
because they fit the support network’s preferences? Might values change in time? How
might practitioners’ own implicit assumptions influence the gathering and evaluation of
clients’ views? That is, in seeking to gather views of others, practitioners are charged to