How do healthcare professionals make decisions concerning low-value care practices? Study protocol of a factorial survey experiment on de-implementation

Marta Roczniewska,Henna Hasson,Sara Ingvarsson,Per Nilsen,Ulrica Von Thiele Schwarz,Hanna Augustsson

doi:10.1186/s43058-021-00153-6

Abstract

BackgroundA large number of practices used in health care lack evidence of effectiveness and may be unnecessary or even cause harm. As such, they should be de-implemented. While there are multiple actors involved in de-implementation of such low-value care (LVC) practices, ultimately, the decision to abandon a practice is often made by each health care professional. A recent scoping review identified 6 types of factors affecting the utilization vs. abandonment of LVC practices. These factors concern health care professionals, patients, outer context, inner context, processes, and the characteristics of LVC practice itself. However, it is unclear how professionals weigh these different factors in and how these determinants influence their decisions about abandoning LVC practices. This project aims to investigate how health care professionals account for various factors as they make decisions regarding de-implementation of LVC practices.MethodsThis project will be carried out in two main steps. First, a factorial survey experiment (a vignette study) will be applied to empirically test the relevance of factors previously identified in the literature for health care professionals’ decision-making about de-implementation. Second, interactive workshops with relevant stakeholders will be carried out to develop a framework for professionals’ decision-making and to offer suggestions for interventions to support de-implementation of LVC practices.DiscussionThe project has the potential to contribute to improved understanding of the decision-making involved in de-implementation of LVC practices. We will identify which factors are more important when they make judgments about utilizing versus abandoning LVC practices. The results will provide the basis for recommendations concerning appropriate interventions to support de-implementation decision-making processes.

Highlights

A large number of practices used in health care lack evidence of effectiveness and may be unnecessary or even cause harm
A factorial survey experiment (FSE) design [21]— known as a vignette experiment—will be applied to test how professionals carry out decision-making processes while considering multiple factors that are likely to affect their decisions
Based on previous experience with this method [33], approximately 3–6 workshops will be conducted. This project aims to contribute to knowledge and practice concerning de-implementation of low-value care (LVC) practices by focusing on the decision-making processes among health care professionals

Summary

Introduction

A large number of practices used in health care lack evidence of effectiveness and may be unnecessary or even cause harm. A recent scoping review identified 6 types of factors affecting the utilization vs abandonment of LVC practices These factors concern health care professionals, patients, outer context, inner context, processes, and the characteristics of LVC practice itself. It is unclear how professionals weigh these different factors in and how these determinants influence their decisions about abandoning LVC practices. While lists of non-recommended practices have become common (e.g., Choosing Wisely [6] or the Swedish National Board of Health and Welfare’s “not to do” label in the guidelines), they have little chance of leading to improvements without sufficient knowledge about efficient de-implementation—that is, translating the what should be de-implemented into how this should be carried out [5, 7, 8]

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