'We don't have recipes; We just have loads of ingredients': Explanations of evidence and clinical decision making by speech and language therapists

Rationale, aims and objectives Research findings consistently suggest that speech and language therapists (SLTs) are failing to draw effectively on research-based evidence to guide clinical practice. This study aimed to examine what constitutes the reasoning provided by SLTs for treatment choices and whether science plays a part in those decisions. Method This study, based in Ireland, reports on the qualitative phase of a mixed-methods study, which examined attitudes underpinning treatment choices and the therapy process. SLTs were recruited from community, hospital and disability work settings via SLT managers who acted as gatekeepers. A total of three focus groups were run. Data were transcribed, anonymized and analysed using thematic analysis. Results In total, 48 participants took part in the focus groups. The majority of participants were female, represented senior grades and had basic professional qualifications. Three key themes were identified: practice imperfect; practice as grounded and growing; and critical practice. Findings show that treatment decisions are scaffolded primarily on practice evidence. The uniqueness of each patient results in dynamic and pragmatic practice, constraining the application of unmodified therapies. Conclusion The findings emerging from the data reflect the complexities and paradoxes of clinical practice as described by SLTs. Practice is pivoted on both the patient and clinician, through their membership of groups and as individuals. Scientific thinking is a component of decision making; a tool with which to approach the various ingredients and the dynamic nature of clinical practice. However, these scientific elements do not necessarily reflect evidence-based practice as typically constructed