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Table 2 Facilitators and barriers

From: Characteristics of communication guidelines that facilitate or impede guideline use: a focus group study

Theme Guideline characteristics
Procedural development flaws - Supporting evidence is not convincing
  - Lack of instructions for use
  - Guideline developers are not representative of the target group
Assumptive flaws Erroneous assumptions about patients
  - Not all patients are equal negotiating partners.
  - Not all patients have a background in Western culture.
  - Not all patients present with a new, well defined medical complaint.
  - Not all patients come by themselves.
  Erroneous assumptions about doctors
  - Not all communication is verbal.
  - Doctors need to be in charge.
  - Experienced doctors communicate differently.
  - Doctors want to have the opportunity to express a personal interest in their patients.
  - Using the guideline is too energy consuming
  Erroneous assumptions about the situation
  - Different situations need different approaches.
  - The guideline does not support long-term patient management strategies.
Impact on the consultation process + More grip on the consultation;
  + More clarity for patients;
  - Less focus on the 'here and now'.
Other impact + Higher quality of consultations;
  + Does justice to both patient and doctor;
  + Less chance of jumping to conclusions;
  + Fewer unreasonable patients;
  - Loss of time;
  - Loss of natural interaction and personal style;
  - Creating anxiety in patients.
  1. Facilitating factors (+) and barriers (-) to guideline use, by theme