Related Experiment Video
Updated: Aug 7, 2026
Using Visual and Narrative Methods to Achieve Fair Process in Clinical Care
Published on: February 17, 2011
Qualitative study of cardiologists' perceptions of factors influencing clinical practice decisions
Veena Manja1, Gordon Guyatt2, John You3
1Department of Surgery, University of California Davis, Davis, California, USA.
Insights
Cardiologists
Area of Science:
- Healthcare Management
- Clinical Decision-Making
- Health Economics
Background:
- Rising healthcare costs in the USA and Canada are partly due to services not improving health outcomes.
- Evidence-based clinical practice guidelines have had limited success in reducing healthcare waste.
- Understanding cardiologists' decision-making factors is key to improving health system efficiency.
Purpose of the Study:
- To explore the perceptions of cardiologists regarding factors influencing their clinical decision-making.
- To identify barriers and facilitators to efficient, evidence-based care in cardiology.
Main Methods:
- A descriptive qualitative study involving in-depth interviews with 21 cardiologists (18 American, 3 Canadian).
- Conventional content analysis using inductive and deductive approaches.
- Findings were mapped to the ecological systems framework.
Main Results:
- Key practice determinants include interpersonal interactions, financial incentives, and system factors.
- Patient insurance status, time constraints, fear of litigation, and patient demands significantly influence decisions.
- American cardiologists cited system income needs; Canadian cardiologists cited personal income implications.
- Knowledge gaps and logistical issues hinder cost-related patient assistance.
- Guidelines had limited influence, with some cardiologists expressing skepticism.
Conclusions:
- Cardiologists' decisions are influenced by a complex interplay of individual, interpersonal, organizational, financial, and sociopolitical factors, more so than guidelines.
- Effective strategies for efficient, evidence-based care must address these socioecological influences on decision-making.
Background:
Healthcare costs are increasing in the USA and Canada and a substantial portion of health spending is devoted to services that do not improve health outcomes. Efforts to reduce waste by adopting evidence-based clinical practice guideline recommendations have had limited success. We sought insight into improving health system efficiency through understanding cardiologists' perceptions of factors that influence clinical decision-making.
Methods:
In this descriptive qualitative study, we conducted in-depth interviews with 18 American and 3 Canadian cardiologists. We used conventional content analysis including inductive and deductive approaches for data analysis and mapped findings to the ecological systems framework.
Results:
Physicians reported that major determinants of practice included interpersonal interactions with peers, patients and administrators; financial incentives and system factors. Patients' insurance status represented an important consideration for some cardiologists. Other major influences included time constraints, fear of litigation (less prominent in Canada), a sense that their obligation was never to miss any underlying pathology, and patient demands. The need to bring income into their health system influenced American cardiologists' practice; personal income implications influenced Canadian cardiologists' practice. Cardiologists reported that knowledge limitations and logistical challenges limit their ability to assist patients with cost considerations. All these considerations were more influential than guidelines; some cardiologists expressed a high level of scepticism regarding guidelines.
Conclusions:
Clinical decision-making by cardiologists is shaped by individual, interpersonal, organisational, environmental, financial and sociopolitical influences and only to a limited extent by guideline recommendations. Successful strategies to achieve efficient, evidence-based care will require addressing socioecological influences on decision-making.
Related Concept Videos
01:27Ethical Issues
Ethical Concerns in Healthcare:
01:30Ethical Dilemmas II
01:23Types of Biopharmaceutical Studies: Controlled and Non-Controlled Approaches
Non-controlled studies, commonly employed for initial exploration, lack a control group, rendering them susceptible to biases and external influences. In contrast, controlled...
01:23Assessment of the Cardiovascular System I: Subjective Data
Initial Enquiry
Ask the patient about their primary concern and thoroughly explore all reported symptoms.
Medical History
Investigate past illnesses affecting the cardiovascular system, such as angina, anemia, rheumatic fever, congenital heart disease, stroke, thrombophlebitis, dysrhythmias, varicosities
Inquire about symptoms...
01:19Pericarditis II: Clinical Features and Diagnostic Tests
01:29Cardiomyopathy V: Interprofessional Care