Montini Theresa, Graham Ian D
The Sophie Davis School of Biomedical Education, City University of New York, 160 Convent Avenue, New York, NY, 10031, USA.
School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, 451 Smyth Road, Ottawa, Ontario, K1H 8M5, Canada.
Implement Sci. 2015 Feb 13;10:24. doi: 10.1186/s13012-015-0211-7.
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.
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.
在其关于“针对矛盾、未经证实和有抱负的医疗实践进行基于证据的去实施”的文章中，普拉萨德和伊奥安尼迪斯（《国际外科杂志》9:1，2014年）提到了阻碍基于证据的去实施的超科学“根深蒂固的实践和其他偏见”。
以根治性乳房切除术的去实施为例，我们对“根深蒂固的实践和其他偏见”进行了分类，并分析了对去实施产生阻力的历史、经济、专业和社会力量。我们发现，即使有证据表明该手术应被去实施，这些超科学因素仍在起作用，以维持对根治性乳房切除术的坚持，因为使根治性乳房切除术得以存在的因素超出了个体临床医生的控制范围。我们建议通过纳入超科学因素来扩展去实施理论。如果我们的目标结果是适当且及时的去实施，社会科学分析将阐明医疗从业者的实践背景，并通过指出导致系统变革的途径来促进去实施。我们分析的意义使我们认为，干预临床医生工作的更广泛背景——社会、政治和经济领域——而不是关注医疗专业人员的行为，可能确实是实现变革的富有成效的方法。
