Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2007 Dec;57(545):971-8.
doi: 10.3399/096016407782604820.

Thou shalt versus thou shalt not: a meta-synthesis of GPs' attitudes to clinical practice guidelines

Benedicte Carlsen  1 , Claire Glenton, Catherine Pope
Affiliations

Thou shalt versus thou shalt not: a meta-synthesis of GPs' attitudes to clinical practice guidelines

Benedicte Carlsen et al. Br J Gen Pract. 2007 Dec.

Abstract

Background: GPs' adherence to clinical practice guidelines is variable. Barriers to guideline implementation have been identified but qualitative studies have not been synthesised to explore what underpins these attitudes.

Aim: To explore and synthesise qualitative research on GPs' attitudes to and experiences with clinical practice guidelines.

Design of study: Systematic review and meta-synthesis of qualitative studies.

Method: PubMed, CINAHL, EMBASE, Social Science Citation Index, and Science Citation Index were used as data sources, and independent data extraction was carried out. Discrepancies were resolved by consensus. Initial thematic analysis was conducted, followed by interpretative synthesis.

Results: Seventeen studies met the inclusion criteria. Five were excluded following quality appraisal. Twelve papers were synthesised which reported research in the UK, US, Canada, and the Netherlands, and covered different clinical guideline topics. Six themes were identified: questioning the guidelines, GPs' experience, preserving the doctor-patient relationship, professional responsibility, practical issues, and guideline format. Comparative analysis and synthesis revealed that GPs' reasons for not following guidelines differed according to whether the guideline in question was prescriptive, in that it encouraged a certain type of behaviour or treatment, or proscriptive, in that it discouraged certain treatments or behaviours.

Conclusion: Previous analyses of guidelines have focused on professional attitudes and organisational barriers to adherence. This synthesis suggests that the purpose of the guideline, whether its aims are prescriptive or proscriptive, may influence if and how guidelines are received and implemented.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Study inclusion/exclusion process.
See this image and copyright information in PMC

References

    1. Grimshaw JM, Thomas RE, MacLennan G, et al. Effectiveness and efficiency of guideline dissemination and implementation strategies. Health Technol Assess. 2004;8(6):iii–iv. - PubMed
    1. Lomas J, Anderson G, Domnick-Pierre K, et al. Do practice guidelines guide practice? The effect of a consensus statement on the practice of physicians. N Engl J Med. 1989;321(19):1306–1311. - PubMed
    1. Stewart RE, Vroegop S, Kamps GB, et al. Factors influencing adherence to guidelines in general practice. Int J Technol Assess Health Care. 2003;19(3):546–554. - PubMed
    1. Berry SR, Hubay S, Soibelman H, Martin DK. Medical oncologists' perceptions of the effect of drug funding decisions for new cancer drugs on their practice: a qualitative study. J Clin Oncol. 2005;23(Suppl 16):6087.
    1. Eccles MP, Grimshaw JM. Selecting, presenting and delivering clinical guidelines: are there any ‘magic bullets’? Med J Aust. 2004;180(Suppl 6):S52–S54. - PubMed

Publication types