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Understanding professional stakeholders’ active resistance to guideline implementation: The case of Canadian breast screening guidelines

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  • Wang, Zhicheng
  • Bero, Lisa
  • Grundy, Quinn

Abstract

Health guidelines aim to improve patient outcomes through the promotion of evidence-based practice. Yet, when a guideline's recommendations significantly differ from, or threaten the interests, values and preferred practices of end-users, organised and often very public resistance to guideline implementation may result. To explore this phenomenon, we theorise a case study consisting of the public discourse following the update to a primary care breast screening guideline in Canada in 2018. Informed by sociological perspectives on the professions and evidence-based medicine, this paper aims to explore: [1] why professional stakeholders form active resistances to the implementation of some clinical guidelines; and, [2] how professional values, perspectives, interests and/or experiences influence the stakeholders' stance. Current understandings have taken a reductive approach in conceptualising the exclusion of experts and their resistance as “conflict of interest.” Rather, we suggest that resistance is the product of multiple areas of contention, stemming from tensions related to clinical and professional autonomy, medical jurisdiction, and the role of medical elites. We highlight considerations for future guideline development and implementation process changes to mitigate and resolve issues related to active resistance. These considerations include understanding resistance as a political strategy, increasing transparency of public input and coalition building as a part of the public response to active resistance.

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  • Wang, Zhicheng & Bero, Lisa & Grundy, Quinn, 2021. "Understanding professional stakeholders’ active resistance to guideline implementation: The case of Canadian breast screening guidelines," Social Science & Medicine, Elsevier, vol. 269(C).
    • Handle: RePEc:eee:socmed:v:269:y:2021:i:c:s0277953620308054
    DOI: 10.1016/j.socscimed.2020.113586
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    References listed on IDEAS

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    1. Goldenberg, Maya J., 2006. "On evidence and evidence-based medicine: Lessons from the philosophy of science," Social Science & Medicine, Elsevier, vol. 62(11), pages 2621-2632, June.
    2. Bowleg, L., 2012. "The problem with the phrase women and minorities: Intersectionality-an important theoretical framework for public health," American Journal of Public Health, American Public Health Association, vol. 102(7), pages 1267-1273.
    3. Lisa Cosgrove & Sheldon Krimsky, 2012. "A Comparison of DSM-IV and DSM-5 Panel Members' Financial Associations with Industry: A Pernicious Problem Persists," PLOS Medicine, Public Library of Science, vol. 9(3), pages 1-4, March.
    4. Susan L Norris & Haley K Holmer & Lauren A Ogden & Brittany U Burda, 2011. "Conflict of Interest in Clinical Practice Guideline Development: A Systematic Review," PLOS ONE, Public Library of Science, vol. 6(10), pages 1-6, October.
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    As found by EconAcademics.org, the blog aggregator for Economics research:
    1. Chris Sampson’s journal round-up for 25th January 2021
      by Chris Sampson in The Academic Health Economists' Blog on 2021-01-25 12:01:17

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    Cited by:

    1. Lagerlöf, Helena & Eriksson, Lena & Sager, Morten, 2024. "Organizing implementation in healthcare: Balancing orders of worth," Social Science & Medicine, Elsevier, vol. 340(C).

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