Abstract
BackgroundDespite the attempt to integrate evidence-based practice (EBP) in patient counseling and advocacy, there is limited knowledge on the status quo of this process in the German health care system. Our objective was to identify important determinants influencing the application of EBP in the counseling and advocacy setting in Germany.MethodsWe carried out a qualitative study performing semi-structured expert interviews and one group discussion among n = 9 patient counselors (PCs) and patient advocates (PAs) identified via expert recommendations and by contacting relevant institutions. The interview manual was developed on the basis of a literature review on barriers/facilitators of EBP in health care delivery and a preamble oriented pyramid discussion with a multidisciplinary team. Interviews were analyzed using the Grounded Theory method. A paradigm was developed to present the interrelations between hindering and facilitating factors for EBP and the attitude towards the utilization of EBP among PAs and PCs.ResultsFindings from nine face-to-face interviews and one group discussion demonstrate that by now PCs and PAs do not recognize EBP as a tool to facilitate the professionalization of patient counselors and advocates. This result is due to individual and institutional barriers such as cognitive-behavioral, professional, attitude related as well as resource and system barriers. PCs and PAs have predominantly critical attitudes towards EBP caused by a lack of trust in its reliability and by concerns regarding unfavorable effects EBP may have on the relationship with the patient and on the cooperation with physicians. A missing infrastructure of needs-based EBP training programs also discourages PCs and PAs from engaging in EBP. Despite the numerous hindering factors, there is also a growing awareness that EBP could help to improve patient counseling and advocacy. To facilitate EBP in future, needs-based training programs and health policy interventions that support interdisciplinary collaboration are required.ConclusionAlthough EBP among PCs and PAs is gaining importance, it is still less likely to be recognized as helpful and its application faces various barriers. More needs-based EBP training programs and health policy interventions to decrease barriers and foster interdisciplinary collaboration are necessary.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-015-0979-9) contains supplementary material, which is available to authorized users.
Highlights
Despite the attempt to integrate evidence-based practice (EBP) in patient counseling and advocacy, there is limited knowledge on the status quo of this process in the German health care system
We neither know whether patient counselors (PCs) and advocates (PAs) are knowledgeable in the basic skills required for the application of EBP, nor do we have sufficient insights into the various factors influencing a successful uptake of EBP among Patient counselor (PC) and Patient advocate (PA) in Germany
A thorough analysis of the qualitative data yields the finding that PCs and PAs do not recognize EBP as a tool to support their vocational professionalization
Summary
Despite the attempt to integrate evidence-based practice (EBP) in patient counseling and advocacy, there is limited knowledge on the status quo of this process in the German health care system. Institutional factors encompass environmental barriers/ facilitators in health care organizations (e.g. resources, time, peer influence, institutional culture) [8,9,10,11,12,13] In this regard, individual EBP barriers of health care professionals include a lack of knowledge in and limited awareness of EBM concepts, a rather negative attitude towards EBM methods and EBP strategies, and a lack of self-confidence to perform EBP due to a self-perceived lack of competency and limited sense of authority or responsibility. Insights in the perceived hindering and facilitating factors of EBP in patient counseling and advocacy in the German health care context are scarce [5] To address this knowledge gap, we performed a qualitative study on the perceived barriers and facilitators of EBP in the daily vocational practice of PCs and PAs working in counseling and advocacy facilities in Germany. Our main objective was to identify important determinants influencing the implementation and application of EBP in the counseling and advocacy setting
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