Translation of clinical practice guidelines on lifestyle behavior in a psychiatric setting. A discourse analytical case study

Abstract

AbstractIntroductionImplementation of clinical practice guidelines (CPGs) can be constrained by diverging guideline interpretations, leading to a discrepancy between the intended clinical practice and the clinical practice implemented. We examine how CPGs on lifestyle behavior for psychiatric inpatients are translated into clinical daily practice, and how this was affected by discourses surrounding the stakeholders.MethodsWe conducted a comparative case study within two psychiatric wards in Denmark, wherein a clinical practice guideline (CPG) addressing lifestyle behavior was implemented. The objective of the CPG was to strategically intervene in the prevalence of unhealthy lifestyle practices among inpatients. Critical discourse analysis and a perspective of translation formed the theoretical framework. We collected empirical material at two stakeholder levels; the CPG authors and clinicians. This included documents related to the CPGs, field observations and two focus group interviews with clinicians.ResultsThe CPG were composed within a system-centered discourse where lifestyle intervention was considered relevant for all inpatients. The clinicians translated the CPGs within a person-centered discourse and a prioritization discourse, focusing on individual factors such as the patient’s own wishes, surplus energy, and the status of the psychiatric treatment.ConclusionThe findings show that implementation of guidelines in their original form cannot be anticipated, but will constitute translation based on social structures and their discourses. Unawareness of this phenomenon called translation may affect implementation and should be considered when CPGs are developed and launched. Future research should explore how discourses and social processes among patients influences implementation of CPGs.What is known on this topic?Several barriers explaining why clinical practice guidelines are not followed by intention has been reportedLess is known about the situations in which the clinicians believe that they follow the guidelines, but translate the content of them unintentionallyWhat this study adds to existing knowledgeOur findings show how clinical practice guidelines can be translated according to the discourses and social processes surrounding the different stakeholders. In this study, clinicians unintentionally changed the practice intented in the guidelines.The clinical practice guidelines arose from a system-centered discourse, expecting all patients to have the same need for lifestyle intervention.The dissemination of the clinical practice guidelines was formed by a patient-centered and a prioritations discourse, focusing on the patients’ individual needs.What are the implications for practice?Clinical practice guidelines are translated differently by stakeholders, and cannot be expected to be implemented in its original form.Policy makers should be aware of this phenomenom called translation, as it is pivotal to align perceptions of clinical practice guidelines or interventions across stakeholders.