Guidelines in situ

Fiona Moffatt, Thinking about guidelines:

My research interest lies predominantly in the notion of knowledge translation, exploring the complex, non-linear relationship between what is ‘known’ and what is subsequently ‘done’. I understand evidence based guidelines and evidence based policy as key rhetorical devices (or technologies) bridging the liminal space between empirical knowledge and clinical practice. My methodological perspective is however, strongly influenced by the sociological discipline of STS, whereby all technologies are contingent, i.e. rejecting technological determinism.

Science and technology are social activities, and the agents (researchers, technologists, healthcare professionals, patients) are members of communities trained in certain practices and with immanent virtues, values and beliefs. Consequently, the resultant interpretations of knowledge are complex and various. Claims, theories, facts and artefacts have very different meanings to different audiences.

Evidently, I am therefore interested in the social construction of knowledge. At a crude level we can ask ourselves,

‘do evidence based guidelines/policies normalise in practice?’ and

‘what are the sociocultural moderators?’

Much work has been undertaken in this field – in my own work I have developed understanding about the influence of governance arrangements, power, neoliberalism, identity, prevailing logics of professionalism, compatibility with existing practice etc. However, what I believe remains under explored is an exposé of the ways in which ‘evidence’ is cognitively appraised. What can we say about evidential pluralism? What are the various epistemological and ontological assumptions between professions, and what are the resultant power dynamics produced? How can healthcare professionals navigate their ultimate position – in what ways do they modify or re-interpret the evidence to match their own philosophical assumptions and reconcile this with the perceived needs of their healthcare context? Could a dispositionalist approach help us to better understand this process? And could this knowledge then impact upon a re-conceptualisation of EBM?

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