| Non clinical influences, beyond diagnosis and severity, on clinical decision making in dermatology: understanding the gap between guidelines and practice. | |
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MedLine Citation:
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PMID: 20500794 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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Abstract Background Clinical decision making in dermatology is a complex process and might be influenced by a wide range of non clinical factors. Objectives The aim of this study was to explore the role of non clinical influences, beyond diagnosis and severity, on clinical decision making in dermatology. Methods Semi structured qualitative interviews were conducted with 46 clinicians working in the departments of dermatology of nine different hospitals in Wales. Interviews were audio-recorded and later transcribed and their contents analysed. Results Non clinical factors influencing patient management decisions in dermatology that were identified related to patients, clinicians and practice characteristics. Patient-related factors included place of residence, socioeconomic circumstances, education and intelligence, ethnicity, age, treatment adherence, expectations from treatment, quality of life, concerns and worries, difficult patients, and family members or friends. Clinician-related factors included time constraints in clinic, clinicians' personal circumstances, relationship with colleagues, and relationship with pharmaceutical companies. Practice-related factors included working in private practice, cost of treatment to NHS, prescribing bureaucracy, and availability of treatment service in the work place. There was a difference between the consultants' views and those of the other clinicians over the impact of pharmaceutical companies on clinicians' prescribing and the awareness of treatment costs to the NHS. Most of the factors identified could potentially influence the clinicians' decision making process subconsciously. Some clinicians highlighted that these factors are untaught in the medical curriculum, and are usually ignored in clinical guidelines, and therefore represent a challenge to the practice of evidence based medicine. Conclusion This study has described one aspect of the reality of medical decision making beyond the conventional evidence based guidelines approach. Proper understanding of non clinical influences on decision making is of paramount importance for the best patient-centred treatment outcomes. |
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Authors:
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F M Hajjaj; M S Salek; M K A Basra; A Y Finlay |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2010-5-25 |
Journal Detail:
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Title: The British journal of dermatology Volume: - ISSN: 1365-2133 ISO Abbreviation: - Publication Date: 2010 May |
Date Detail:
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Created Date: 2010-5-26 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0004041 Medline TA: Br J Dermatol Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Affiliation:
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Department of Dermatology and Wound Healing, Cardiff University School of Medicine, Cardiff CF14 4XN. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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