Making research evidence usable is not enough: clinicians’ use of patient- and caregiver-informed evidence-based recommendations in routine care—a qualitative study

Abstract Background Evidence-based medicine requires clinicians to integrate the best available research evidence, clinical expertise, and patient preferences. Evidence-based recommendations can make synthesized evidence easier to access and use, but making evidence available does not necessarily make clinical decisions responsive to patient and caregiver priorities. Participatory approaches to knowledge translation may help by involving patients and caregivers in selecting and framing recommendations before dissemination. Yet little is known about how clinicians later use recommendations shaped through such upstream participation. This study examined a knowledge translation initiative in which patients, caregivers, clinicians, and evidence-based medicine experts prioritized evidence-based recommendations, which were then disseminated through one-way channels—including printed materials, email, mobile messages, and web-based platforms—without ongoing dialogue or implementation support. We explored how clinicians used these recommendations and how health system conditions influenced whether patient and caregiver preferences were considered in routine clinical decisions. Methods We conducted 22 semi-structured interviews with 13 clinicians one year after their exposure to a dissemination initiative that distributed 40 evidence-based recommendations prioritized from 527 candidate recommendations. The initiative used printed materials, email, mobile messages, and web-based platforms. Participants were recruited through purposive sampling across primary, secondary, and tertiary healthcare settings. Data were collected between February and June 2023 and analyzed thematically using Braun and Clarke’s approach. Results Clinicians described the recommendations as accessible and educationally valuable. They reported that the materials reinforced evidence-informed prescribing, diagnostic reasoning, and clinical confidence. However, patient- and caregiver-relevant elements embedded in some recommendations were more often used for information provision, adherence counselling, and patient education than for explicit consideration of individual preferences during clinical decisions. Restricted consultation time, administrative authorization requirements, fragmented care, and socioeconomic barriers influenced how clinicians could apply recommendations and engage with patient and caregiver priorities. Conclusions Disseminating evidence-based recommendations selected and framed with patients, caregivers, clinicians, and evidence-based medicine experts through these one-way channels makes a useful but insufficient contribution. It can make patient and caregiver priorities available to clinicians and support evidence-informed practice, but it does not by itself ensure that these priorities inform clinical decisions. Participatory knowledge translation must also address the health system barriers that constrain the use of patient and caregiver preferences in evidence-based medicine. Clinical trial number Not applicable.