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JCPSLP
Volume 16, Number 1 2014
Journal of Clinical Practice in Speech-Language Pathology
an easy process – decisions regarding need and priority
can be a source of great anxiety when they need to be
balanced with equity and prognosis (Kenny, Lincoln, Blyth
& Balandin, 2009). Furthermore, clinicians must be vigilant
against gradually “watering down” best practice in response
to resource constraints.
In accordance with utilitarian and justice principles,
Lafrenière, Hurliman, Menuz and Godard (2013) reviewed
the available KT literature and developed guiding questions
for incorporating ethics into each step of the Knowledge
to Action Process Framework (Graham et al., 2006). The
summary presented in the following section, was drawn
from their list of guiding questions.
Ethics applied to the Knowledge to
Action Framework
During stages of
knowledge creation
, participants must
make an informed and autonomous choice regarding their
involvement in the research. Participants’ privacy and the
confidentiality of their personal information must be
protected and strategies must be in place to avoid harming
participants during research processes or in the
presentation of findings (Smith, 2003). There must also be
appropriate rationales for excluding individuals or groups
from research opportunities because exclusion may result
in some members of the community having no voice during
the knowledge creation process (Leitão et al., 2012).
Identification of research problems
must be based
upon health care priorities. The needs and motivations of
stakeholders need to be articulated and decision-making
processes made transparent. The human, financial,
temporal, and material resources invested in a research
problem are expected to provide knowledge that will benefit
individuals and society and such investments must be
directed towards research that may have relatively greater
benefits for a profession and community. To ensure this
outcome, it is imperative that clinicians either communicate
with researchers so that real clinical issues are pursued, or
that clinicians undertake research in their clinical practice.
Indeed, we need to close the gap between clinicians and
researchers so that clinicians can direct research according
to clinical need and researchers translate their findings into
clinically useful strategies (Davies, Robertson, Stevens &
Thomas, 2006). The Clinical Centre for Research Excellence
in Australia, for example, has engaged in a comprehensive
process of community engagement and developed
strategies for translating aphasia research into innovative
practice (Power & Worrall, 2011).
Knowledge must be adapted
to the culture and
worldview of consumers so that they may benefit from
new approaches. Lafrenière et al. (2013) argued, for
example, that the limited effectiveness of some public
health programs in indigenous communities may be
due to externally imposed strategies that ignore local
understandings of health and illness and cultural
mechanisms for sharing knowledge. Factors that may result
in misapplication of knowledge and misuse of resources
must be identified and addressed to avoid harming
communities or individuals. Again, a close relationship
between researchers, clinicians and the community may
enhance the likelihood that knowledge will not be applied
inappropriately and the best evidence will reach targeted
communities (Kagan, Simmons-Mackie, Brenneman,
Conklin & Elman, 2010).
knowledge brokers, policy makers, decision makers,
and the community)?
3. When is it appropriate to implement new knowledge
with clinical populations?
4. What types of outcomes should be considered during
the creation and action cycles of KT?
5. What mechanisms can be used to align KT processes
with ethically sound practice?
When reflecting upon these questions, one must
be mindful that ethically sound KT is underpinned by
three key features (Graham & Tetroe, 2007). First, KT is
grounded in the ethical principles of beneficence (to do
good) and non-maleficence (to avoid harm). In keeping
with these principles, KT aims to develop safe and
efficacious interventions that avoid harm and provide
significant benefits to clients. These aims depend upon
researchers to provide valid and reliable evidence before
findings are disseminated to practitioners. These aims also
depend upon clinicians eschewing non-evidence-based
practices that may be marketed to vulnerable clients
through unregulated internet sources (Meredith, Firmin &
McAllister, 2013). Moreover, clinicians must respond to the
community expectations regarding access to knowledge
in a format that is appropriate for their needs (O’Halloran
& Rose, 2010). Second, KT interventions must meet
ethical standards and comply with the legal and regulatory
frameworks of the profession. The second feature
acknowledges the role of the Professional Association and
Board of Ethics in clearly articulating professional values
that govern the application of knowledge. The third feature
of KT is that the social and economic consequences
of an intervention must be carefully considered since
sustainability of health care programs may be impacted by
budgetary constraints. This feature addresses the complex
interplay between evidence and economics and the aims
for KT to guide judicious use of health care resources.
In other words, the “how, when and with whom”, new
knowledge is adopted in health care settings. These vexing
issues have been addressed with ethical analysis.
Trevor-Deutsch, Allen and Ravitsky (2009) proposed a
bioethical framework for KT based upon dual perspectives
of utility and justice. Utilitarian perspectives dictate that
decisions should be based upon achieving the greatest
benefit for the greatest number of people (Freegard, 2006).
Hence, any new practice or innovation should attempt
to maximise benefits while taking commensurate steps
to minimise risks. Further, resource allocation decisions
should be based upon potential benefit to individuals and
society. Evaluation of benefits and risks is multidimensional
and needs to incorporate holistic and long-term vision.
For example, a decision to provide an adult client with
dysphagia treatment but limited or no communication
intervention may initially appear ethically sound when
a speech pathologist cannot meet caseload demands.
However, such a decision fails to take into account the
potential impacts of aphasia and the importance of
rehabilitation during the early stages of recovery (Grohn,
Worrall, Simmons-Mackie & Brown, 2012). A justice
perspective determines that benefits resulting from KT
should be fairly distributed among individuals, and within
and among communities (Berglund, 2007). Here, justice
is not simply interpreted as “each receives the same”
but incorporates a concept of “each according to need”
(Edwards, 1996). Just and fair resource allocation is not
