Please use this identifier to cite or link to this item: http://hdl.handle.net/1959.13/806918

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Title
Evidence-based healthcare in practice: a study of clinician resistance, professional de-skilling, and inter-specialty differentiation in oncology
Author/Creator
Broom, Alex;  Adams, Jon;  Tovey, Philip
Institution
The University of Newcastle. Faculty of Education & Arts, School of Humanities and Social Science
Description
Evidence-based medicine (EBM) is strongly shaping the nature and direction of biomedical practice and organisational culture. Clinicians are now expected to adopt the principles of EBM and evidence-based practice (EBP) whilst also maintaining such things as professional autonomy, clinical judgement and therapeutic integrity. Little sociological work has been done on the implications of EBM in oncology contexts. Drawing on in-depth interviews with 13 oncology consultants and 12 oncology nurses in Australia, in this paper we explore how oncology clinicians utilise and/or critique types of evidence and statistical probabilities; the organisational systematisation of care; and, wider policies of EBM. The results illustrate significant variation in perception of EBM between the oncology sub-specialties examined, and the central role of organisational structures and intra-professional hierarchies in how evidence is viewed and utilised in practice. The interviews also capture the ways in which oncology specialists are negotiating the systematisation of care under the rubric of EBM, and the contradictory effects of professional de-skilling vis-à-vis the reinforcement of biomedical objectivity/power. Finally, we examine the experiences and perceptions of oncology nurses in relation to evidence and EBM, exploring the interplay of processes of professionalisation and distinction in shaping the evidence-based trajectories of nursing. We contrast these results with previous sociological writings on EBM, reflecting on the applicability and limitations of these theoretical positions when applied to the experiences of oncology clinicians.
Relation
Social Science and Medicine Vol. 68, Issue 1, p. 192-200
Publisher Link
http://dx.doi.org/10.1016/j.socscimed.2008.10.022
Date
2009
Publisher
Elsevier
Keyword(s)
Australia;  cancer;  qualitative;  evidence-based medicine;  de-skilling
Resource Type
journal article
Identifier
http://hdl.handle.net/1959.13/806918
Identifier
ISSN:0277-9536
Reviewed
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Subject
"Social Science and Medicine"
 
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