"Entrenched practices and other biases": unpacking the historical, economic, professional, and social resistance to de-implementation

Implement Sci. 2015 Feb 13;10:24. doi: 10.1186/s13012-015-0211-7.

Abstract

Background: In their article on "Evidence-based de-implementation for contradicted, unproven, and aspiring healthcare practices," Prasad and Ioannidis (IS 9:1, 2014) referred to extra-scientific "entrenched practices and other biases" that hinder evidence-based de-implementation.

Discussion: Using the case example of the de-implementation of radical mastectomy, we disaggregated "entrenched practices and other biases" and analyzed the historical, economic, professional, and social forces that presented resistance to de-implementation. We found that these extra-scientific factors operated to sustain a commitment to radical mastectomy, even after the evidence slated the procedure for de-implementation, because the factors holding radical mastectomy in place were beyond the control of individual clinicians. We propose to expand de-implementation theory through the inclusion of extra-scientific factors. If the outcome to which we aim is appropriate and timely de-implementation, social scientific analysis will illuminate the context within which the healthcare practitioner practices and, in doing so, facilitate de-implementation by pointing to avenues that lead to systems change. The implications of our analysis lead us to contend that intervening in the broader context in which clinicians work--the social, political, and economic realms--rather than focusing on healthcare professionals' behavior, may indeed be a fruitful approach to effect change.

Publication types

  • Historical Article
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Breast Neoplasms / history*
  • Breast Neoplasms / surgery
  • Breast Neoplasms / therapy
  • Diffusion of Innovation*
  • Evidence-Based Medicine / economics
  • Evidence-Based Medicine / history
  • Female
  • History, 19th Century
  • History, 20th Century
  • Humans
  • Mastectomy / history*
  • Mastectomy, Radical / history
  • Politics
  • Practice Patterns, Physicians' / economics
  • Practice Patterns, Physicians' / history*
  • Socioeconomic Factors
  • United States