Doctors' perceptions and use of evidence-based medicine: A systematic review and thematic synthesis of qualitative studies

PURPOSE: Many primary qualitative studies of barriers and facilitators for doctors' use of evidence-based medicine (EBM) are available, but knowledge remains fragmented. This study sought to synthesize the results of these qualitative studies, taking the variability across context (i.e., medical disciplines, career stages, practice settings, and time of study) into account. METHOD: The authors searched PubMed through April 26, 2012, and independently selected studies according to prespecified criteria for relevance and methodological quality. Additionally, they performed a thematic synthesis through line-by-line interpretation, coding, and thematic arrangement of information. RESULTS: The search resulted in 1,211 publications, of which 30 studies were included. Five major themes emerged on barriers and facilitators for doctors' use of EBM: individual mind-set, professional group norms, EBM competencies, balance between confidence and critical reflection, and managerial collaboration. The authors found particular barriers and facilitators across career stages. Although clinical experience and professional status were perceived to be helpful, they could also prevent doctors from identifying information needs and adopting new evidence. Although residents' lack of clinical experience raised awareness of information needs, residents perceived lack of clinical experience and their hierarchical dependence on staff as barriers to articulating information needs and to translating and introducing evidence to patient care. CONCLUSIONS: Encouragement of group norms for safe communication and shared learning across career stages is perceived as the most prominent facilitator for EBM.