Background A considerable proportion of interventions provided to patients lack evidence of their effectiveness. This implies that patients may receive ineffective, unnecessary or even harmful care. However, despite some empirical studies in the field, there has been no synthesis of determinants impacting the use of low-value care (LVC) and the process of de-implementing LVC. Aim The aim was to identify determinants influencing the use of LVC, as well as determinants for de-implementation of LVC practices in health care. Methods A scoping review was performed based on the framework by Arksey and O’Malley. We searched four scientific databases, conducted snowball searches of relevant articles and hand searched the journal Implementation Science for peer-reviewed journal articles in English. Articles were included if they were empirical studies reporting on determinants for the use of LVC or de-implementation of LVC. The abstract review and the full-text review were conducted in duplicate and conflicting decisions were discussed until consensus was reached. Data were charted using a piloted data charting form and the determinants were inductively coded and categorised in an iterative process conducted by the project group. Results In total, 101 citations were included in the review. Of these, 92 reported on determinants for the use of LVC and nine on determinants for de-implementation. The studies were conducted in a range of health care settings and investigated a variety of LVC practices with LVC medication prescriptions, imaging and screening procedures being the most common. The identified determinants for the use of LVC as well as for de-implementation of LVC practices broadly concerned: patients, professionals, outer context, inner context, process and evidence and LVC practice. The results were discussed in relation to the Consolidated Framework for Implementation Research. Conclusion The identified determinants largely overlap with existing implementation frameworks, although patient expectations and professionals’ fear of malpractice appear to be more prominent determinants for the use and de-implementation of LVC. Thus, existing implementation determinant frameworks may require adaptation to be transferable to de-implementation. Strategies to reduce the use of LVC should specifically consider determinants for the use and de-implementation of LVC. Registration The review has not been registered.

Background In the implementation of standardized cancer patient pathways (CPPs), the investigatory units, endoscopy, radiology and pathology, are crucial to ensure an eventual cancer diagnosis. However, when evaluating the implementation of CPPs, little attention has been paid to the healthcare professionals working in these units. The aim of this study was to explore experiences of the implementation of CPPs among health professionals in investigatory units. Methods This descriptive qualitative study included 55 health professionals working in investigatory units. Participants were interviewed in 2017–2018, and data were analysed using thematic analysis. Results The health professionals reported benefits, facilitators and challenges when describing their experiences of implementing CPPs. Benefits included that CPP improved collaboration and increased focus on the patients. Facilitators in the implementation process included pre-existing well-functioning work processes and having supportive functions (e.g. coordinators). Challenges included the lack of staff and clinical equipment, as well as unjustified time-slots and incorrect referrals. Conclusions The findings show that most health professionals working in investigatory units’ experience benefits with the implementation of CPP, but the lack of resources was especially hard to overcome.

Globally, incidence of cancer is increasing due to population growth, longer life expectancies and increasing cancer risk factors (Bray et al., 2018). Multi-national studies have shown that patient cancer survival rates differ per country (Coleman et al., 2011;Holmberg et al., 2010;Verdecchia et al., 2007), where outcome differences may be partly explained by the stage of cancer when first diagnosed (Coleman et al., 2011;Maringe et al., 2013).Standardised care pathways (SCPs) have shown to reduce hospital

Background: In the implementation of standardized cancer patient pathways (CPPs), the investigatory units, endoscopy, radiology and pathology, are crucial to ensure an eventual cancer diagnosis. However, when evaluating the implementation of CPPs, little attention has been paid to the healthcare professionals working in these units. The aim of this study was to explore experiences of the implementation of CPPs among health professionals in investigatory units.Methods: This descriptive qualitative study included 55 health professionals working in investigatory units. Participants were interviewed in 2017–2018, and data were analysed using thematic analysis. Results: The health professionals reported benefits, facilitators and challenges when describing their experiences of implementing CPPs. Benefits included that that CPP improved collaboration and increased focus on the patients. Facilitators in the implementation process included pre-existing well-functioning work processes and having supportive functions (e.g. coordinators). Challenges included the lack of staff and clinical equipment, as well as unjustified time-slots and incorrect referrals.Conclusions: The findings show that most health professionals working in investigatory units’ experience benefits with the implementation of CPP, but the lack of resources was especially hard to overcome.