2026-04-17T00:43:38Zhttps://recercat.cat/oai/request

oai:recercat.cat:11351/112572025-10-24T10:59:31Zcom_2072_451665com_2072_378040col_2072_451666

Enablers and barriers to a quaternary prevention approach: a qualitative study of field experts Otte, Jessica Llargués-Pou, Maria Atenció centrada en el pacient Medicina preventiva Investigació qualitativa ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Diagnosis::Clinical Decision-Making DISCIPLINES AND OCCUPATIONS::Health Occupations::Medicine::Public Health::Preventive Medicine HEALTH CARE::Health Services Administration::Patient Care Management::Comprehensive Health Care::Primary Health Care::Patient-Centered Care TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::diagnóstico::toma de decisiones clínicas DISCIPLINAS Y OCUPACIONES::profesiones sanitarias::medicina::salud pública::medicina preventiva ATENCIÓN DE SALUD::administración de los servicios de salud::gestión de la atención al paciente::atención integral de salud::atención primaria de la salud::atención centrada en el paciente Clinical Decision-Making; Preventive medicine; Patient-Centered Care Toma de Decisiones Clínicas; Medicina Preventiva; Atención centrada en el paciente Presa de decisions clíniques; Medicina preventiva; Atenció centrada en el pacient Objective: There is a growing concern about the sustainability of healthcare and the impacts of 'overuse' on patients and systems. Quaternary prevention (P4), a concept promoting the protection of patients from medical interventions in which harms outweigh benefits, is well positioned to stimulate reflection and inspire solutions, yet has not been widely adopted. We sought to identify enablers and barriers to a P4 approach, according to field experts and advocates in one health system. Design: Qualitative methodology, using semistructured interviews and a grounded theory approach facilitated thematic analysis and development of a conceptual model. Setting: Virtual interviews, conducted in British Columbia, Canada. Participants: 12 field experts, recruited based on their interest and work related to P4 and related concepts. Results: Four factors were seen as promoting or hindering P4 efforts depending on context: relationship between patient and clinician, education of clinicians and the public, health system design and influencers. We extracted four broad enablers of P4: evidence-based medicine, personal experiences and questioning attitude, public P4 campaigns and experience in resource-poor contexts. There were six barriers: peer pressure between clinicians, awareness and screening campaigns, cognitive biases, cultural factors, complexity of the problem and industry influence. Conclusions: Elicited facilitators and impediments to the application of P4 were similar to those seen in existing literature but framed uniquely; our findings place increased emphasis on the clinician-patient relationship as central to decision-making and position other drivers as influencing this relationship. A transition to a model of care that explicitly integrates conscious protection of patients by reducing overtesting, overdiagnosis and overtreatment will require changes across health systems and society. 2025-10-24T10:59:31Z 2025-10-24T10:59:31Z 2025-10-24T10:59:31Z 2024-03-28T12:31:08Z 2024-03-28T12:31:08Z 2024-03-19 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion http://hdl.handle.net/11351/11257 BMJ Open;14(3) https://doi.org/10.1136/bmjopen-2023-076836 Attribution-NonCommercial 4.0 International http://creativecommons.org/licenses/by-nc/4.0/ info:eu-repo/semantics/openAccess BMJ Publishing Group Scientia