When a client presents with a particular problem, how should we decide what intervention to offer? Who should be involved in the decision? What do we base it on? This book explores how clinical practitioners think about and deal with such questions, and provides a fascinating and comprehensive overview of the many ways that this decision making can, often unintentionally, drift away from evidence-based practice (EBP).

The early chapters outline and define key concepts such as decision making, critical thinking, and the term EBP, explaining their importance in health and social care settings. Crucially, the book conceptualizes EBP as an ongoing process, and not a distinct status that can be ‘achieved’. The steps involved in this process are clearly described, along with guidance on what constitutes ‘evidence’, how this can be critically evaluated, and how the results of this evaluation can be brought together to inform decision making. Later chapters cover ways in which the process can be led astray, for example via the influence of heuristics and biases, fallacies of logic and reasoning, argumentation issues, and the misuse of language. Clear guidance is given aiming to help clinicians spot and avoid these and clarify communication about clinical decisions. Lastly, common challenges and obstacles to implementing EBP within services are discussed, with thoughtful reflection on the link between EBP and ethical practice. Suggestions for developing structures and skills to support EBP are provided.

The book has many strengths, in particular its coverage of how EBP is often misrepresented, and the term itself misappropriated. It places a welcome emphasis on the value of uncertainty and ignorance; that it is just as important to know that something is unknown or unclear, as it is to know something with reasonable confidence. There is good use of clinical decision-making examples throughout, and many summary tables and lists convey key points succinctly. I would suggest that much of the book’s content is not necessarily emphasized (or taught at all) to clinicians and healthcare researchers within their training, so the book may fill an important gap in helping to understand and implement an empirically grounded, scientist-practitioner approach. The author highlights important ways in which the appropriate use of evidence ties into ethical practice. This includes how common issues such as pseudoscientific claims, or an over-reliance on our own, or others’, clinical experience, can become an ethical issue when they are favoured over more balanced and inclusive consideration of all available evidence. Finally, the book retains a strong focus on the client’s best interests, and involving them within the EBP process wherever possible.

One potential limitation of the book is that there is less consideration of the practicalities of integrating the EBP process into day-to-day practice. Given EBP requires time to formulate appropriate questions and determine the extent of available evidence, the feasibility of this for busy individual practitioners seems a reasonable consideration. Although changes to both personal and organizational practices are suggested and encouraged, it would have been interesting to read more about how this could be done, for example how IT systems or library literature search services could facilitate this, or how to use clinical guidelines most effectively.

The book has broad applicability, being written for all healthcare professions not just psychological therapists. It would be particularly helpful to support practitioners in reflecting on their own practice, and helping service managers consider how EBP can be better integrated within teams and organizations. As the book provides a clear summary of the scientific method as a whole, with concise summaries of potential pitfalls when applying this, it would also be of significant value to supplement teaching, and as a resource for students, trainees, and others involved in designing and appraising research.