Abstract
Background: The process of stopping or reducing provision of existing healthcare interventions is referred to as ‘de-adoption.’ A decision to de-adopt an intervention may be based on new evidence around clinical effectiveness, cost-effectiveness, harms, or due to the introduction of newer interventions that are more clinically or cost effective. De-adoption is widely acknowledged to be difficult to achieve and the reasons for this remain poorly understood. In particular, there is a lack of research on stakeholder perspectives on and experiences of de-adoption initiatives. Addressing this evidence gap has the potential to generate deeper understanding of the barriers and potential solutions for achieving de-adoption which is vital for the sustainability of healthcare systems. In 2019, a national de-adoption programme was rolled out in the English National Health Service called the Evidence-Based Interventions (EBI) programme. This provided the opportunity to investigate patients’ and healthcare professionals’ perspectives on and experiences of a de-adoption initiative.Aim: To investigate patients’ and health care professionals’ perspectives on and experiences of care pathways for managing Dupuytren’s disease (DD) (a hand condition), with a focus on exploring their views about the decision-making processes for Dupuytren’s contracture release (DCR), an intervention targeted by the (EBI) programme.
Methods: A multi-methods case study approach was taken, including analysis of 33 policies from Integrated Care Boards (ICBs) in England for provision of DCR; 31 interviews with patients who had been referred to hospital for assessment of their hand symptoms, 12 interviews with health care professionals, and 21 audio-recorded clinical consultations.
Findings: The policy analysis showed diversity in ICB policies’ specification of when and how DCR criteria should be implemented within care pathways. Interviews with patients showed that not being listed for DCR was generally acceptable, when this outcome was accompanied with education around the reasons for withholding DCR, and there were clear instructions for when to re-consult. However, sources of dissatisfaction were linked to patients’ perceptions of having received inconsistent information regarding referral and treatment thresholds from healthcare professionals they had encountered throughout their care pathways. Furthermore, there was a common belief amongst patients that there were wider NHS prioritisation processes at play, which they attributed to financial scarcity, and in some cases this influenced their expectations of care. Health care professionals generally agreed with the EBI criteria for DCR when reflecting on these during their interviews. Analysis of consultations showed that health care professionals appeared to use EBI criteria as a benchmark to offer DCR to patients, but they rarely explicitly referred to restrictive policies during these encounters.
Conclusion: De-adoption of elective health care interventions using restrictive policies can be acceptable to patients at the point-of-care in some contexts, but future attempts need to consider how these policies should be implemented across the entire care pathway.
| Date of Award | 9 Dec 2025 |
|---|---|
| Original language | English |
| Awarding Institution |
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| Supervisor | Leila Rooshenas (Supervisor), Amanda L Owen-Smith (Supervisor) & William Hollingworth (Supervisor) |
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