Peterson Carol B, Becker Carolyn Black, Treasure Janet, Shafran Roz, Bryant-Waugh Rachel
Department of Psychiatry, University of Minnesota Medical School, F282/2A West, 2450 Riverside Avenue South, Minneapolis, MN, 55454, USA.
The Emily Program, St. Paul, MN, USA.
BMC Med. 2016 Apr 14;14:69. doi: 10.1186/s12916-016-0615-5.
Evidence-based practice in eating disorders incorporates three essential components: research evidence, clinical expertise, and patient values, preferences, and characteristics. Conceptualized as a 'three-legged stool' by Sackett et al. in 1996 (BMJ), all of these components of evidence-based practice are considered essential for providing optimal care in the treatment of eating disorders. However, the extent to which these individual aspects of evidence-based practice are valued among clinicians and researchers is variable, with each of these stool 'legs' being neglected at times. As a result, empirical support and patient preferences for treatment are not consistently considered in the selection and implementation of eating disorder treatment. In addition, clinicians may not have access to training to provide treatments supported by research and preferred by patients. Despite these challenges, integrating these three components of evidence-based practice is critical for the effective treatment of eating disorders.
Current research supports the use of several types of psychotherapies, including cognitive-behavioral, interpersonal, and family-based therapies, as well as certain types of medications for the treatment of eating disorders. However, limitations in current research, including sample heterogeneity, inconsistent efficacy, a paucity of data, the need for tailored approaches, and the use of staging models highlight the need for clinical expertise. Although preliminary data also support the importance of patient preferences, values, and perspectives for optimizing treatment, enhancing treatment outcome, and minimizing attrition among patients with eating disorders, the extent to which patient preference is consistently predictive of outcome is less clear and requires further investigation. All three components of evidence-based practice are integral for the optimal treatment of eating disorders. Integrating clinical expertise and patient perspective may also facilitate the dissemination of empirically-supported and emerging treatments as well as prevention programs. Further research is imperative to identify ways in which this three-legged approach to eating disorder treatment could be most effectively implemented.
饮食失调的循证实践包含三个基本要素：研究证据、临床专业知识以及患者的价值观、偏好和特征。1996年，萨克特等人（《英国医学杂志》）将其概念化为一个“三条腿的凳子”，循证实践的所有这些要素都被认为是在饮食失调治疗中提供最佳护理所必需的。然而，循证实践的这些个体方面在临床医生和研究人员中的受重视程度各不相同，这些凳子的“腿”有时会被忽视。因此，在饮食失调治疗的选择和实施过程中，并未始终考虑实证支持和患者对治疗的偏好。此外，临床医生可能无法获得培训以提供有研究支持且患者偏爱的治疗方法。尽管存在这些挑战，但整合循证实践的这三个要素对于饮食失调的有效治疗至关重要。
当前的研究支持使用几种心理治疗方法，包括认知行为疗法、人际疗法和基于家庭的疗法，以及某些类型的药物来治疗饮食失调。然而，当前研究存在局限性，包括样本异质性、疗效不一致、数据匮乏、需要量身定制的方法以及使用分期模型，这凸显了临床专业知识的必要性。尽管初步数据也支持患者偏好、价值观和观点对于优化治疗、提高治疗效果以及减少饮食失调患者的流失率的重要性，但患者偏好始终能预测治疗结果的程度尚不清楚，需要进一步研究。循证实践的所有三个要素对于饮食失调的最佳治疗都是不可或缺的。整合临床专业知识和患者观点也可能促进实证支持的和新出现的治疗方法以及预防项目的传播。必须进行进一步研究，以确定这种三条腿的饮食失调治疗方法最有效的实施方式。
