Urinary incontinence in the elderly: Attitudes and experiences of general practitioners

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

“…The reason for these exclusions was the belief that the authors' findings were not consistent with or reflective of the data presented. The remaining 12 studies were published between 1998 and 2006, [25][26][27][28][29][30][31][32][33][34][35][36] and were all published in English (Supplementary Table 2). Five of the studies were from the UK, while the remaining seven were from the US, Canada, and the Netherlands.…”

“…[25][26][27]29,30,33,35 GPs also pointed out that the use of narrow inclusion criteria could weaken the applicability of the evidence from trials. Cranney GPs expressed uncertainty about the evidence base in the face of changes over time and controversies.…”

“…In most of the studies, GPs referred to a lack of time to read and assess the guidelines, follow the recommendations, and negotiate with patients, [26][27][28][29][30][32][33][34][35][36] leading Langley and colleagues to refer to GPs' 'white rabbit persona'. 27 Other practical constraints, including convenience, lack of skills with new procedures, and lack of resources, were also referred to:…”

“…[24][25][26][27][28][29][30][31][32][33][34][35] Studies indicated that some GPs were sceptical about the evidence…”

“…[24][25][26][27][28][29][30][31][32][33][34][35] Guidelines were experienced as not flexible enough to take into account the complexity of individual circumstances, such as multiple diagnoses, painful side-effects, and patient preference: GPs' desire to respond to patients' needs and requests sometimes conflicted with the guideline recommendations, and empathy for patients that are suffering or anxious was mentioned as a factor that overruled guidelines in decision making:…”