Charles Perkins Centre, The University of Sydney School of Pharmacy, Faculty of Medicine and Health, Sydney, Australia.
Charles Perkins Centre, The University of Sydney School of Pharmacy, Faculty of Medicine and Health, Sydney, Australia; University of Colorado School of Medicine, Colorado School of Public Health and Center for Bioethics and Humanities, USA.
Soc Sci Med. 2021 Jan;269:113586. doi: 10.1016/j.socscimed.2020.113586. Epub 2020 Dec 5.
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.
健康指南旨在通过推广基于证据的实践来改善患者的治疗效果。然而，当指南的建议与最终用户的利益、价值观和偏好实践显著不同，或者对其构成威胁时，可能会导致有组织的、通常是公开的对指南实施的抵制。为了探究这一现象，我们构建了一个案例研究，该研究包含了加拿大 2018 年对初级保健乳房筛查指南更新后的公共话语。本研究以社会学视角和循证医学为理论基础，旨在探讨：[1]为什么专业利益相关者会对某些临床指南的实施产生积极抵制；以及，[2]专业价值观、观点、利益和/或经验如何影响利益相关者的立场。目前的理解在概念化专家的排斥和他们的抵制时采取了简化的方法，将其视为“利益冲突”。相反，我们认为抵制是多个争议领域的产物，源于与临床和专业自主权、医疗管辖权以及医学精英角色相关的紧张关系。我们强调了未来指南制定和实施过程变化的考虑因素，以减轻和解决与积极抵制相关的问题。这些考虑因素包括将抵制视为一种政治策略，增加公众意见的透明度，并将联盟建设作为积极抵制的公众回应的一部分。
