Nurses' Perceptions on the Overuse of Health Services: A Qualitative Study

Understanding Healthcare Personnel's Perceptions About Reducing Low-Value Care: A Scoping Review

Objective

To systematically and comprehensively search the studies describing healthcare personnel's perceptions about reducing low-value care.

Design

Scoping review.

Methods

Evidence sources included PubMed, ProQuest and CINAHL databases from inception to 13th September 2023, along with grey literature, expert suggestions and reference lists from the included articles. Studies were included if they contained information about healthcare personnel's perceptions and involvement in reducing low-value care. The extracted data included general study characteristics, the type of low-value care of interest, clinical settings, and main findings related to healthcare personnel's perceptions. Three frameworks were used to guide the data synthesis. First, the main findings from the included studies were mapped onto the Process of De-adoption Framework to capture the aspects of low-value care that healthcare personnel focused on, including the identification of low-value care, barriers and facilitators to reducing low-value care, and intervention strategies. The identified barriers and facilitators were then mapped onto the relevant domains of the Theoretical Domains Framework. Finally, the intervention strategies, as informed by healthcare personnel's perceptions, were mapped to the Cochrane Effective Practice and Organization of Care taxonomy framework.

Results

The 37 included studies were those published since 2011. Of these, 15 studies were conducted in the United States. Most included studies (n = 19) described low-value care not specific to a care measure. Twelve of the included studies described healthcare personnel's perceptions regarding the identification of low-value care, 34 studies described healthcare personnel's perceptions regarding influence factors to reducing low-value care and 18 studies described healthcare personnel's perceptions regarding intervention strategies to reduce low-value care. "Knowledge" (n = 16) and 'environmental context and resources' (n = 16) were the most common influence factors of reducing low-value care. "Education" was the most commonly discussed intervention strategy for reducing low-value care (n = 14).

Conclusion

Healthcare personnel's perceptions focused on identifying low-value care, barriers and facilitators of reducing low-value care and intervention strategies to reduce low-value care. Education was potentially the main effect of the intervention strategies in addressing lack of knowledge, which is the main barrier to reducing low-value care. Future research should develop and implement intervention strategies to reduce low-value care based on healthcare personnel's perceptions.

Low-value health care, de-implementation, and implications for nursing research: A discussion paper

Globally, the nursing profession constitutes the largest proportion of the health workforce; however, it is challenged by widespread workforce shortages relative to need. Strategies to promote recruitment of the nursing workforce are well-established, with a lesser focus on strategies to alleviate the burden on the existing workforce. This burden may be exacerbated by the impact of low-value health care, characterised as health care that provides little or no benefit for patients, or has the potential to cause harm. Low-value health care is a global problem, a major contributor to the waste of healthcare resources, and a key focus of health system reform. Evidence of variation in low-value health care has been identified across countries and system levels. Research on low-value health care has largely focused on the medical profession, with a paucity of research examining either low-value health care or the de-implementation of low-value health care from a nursing perspective. The objective of this paper is to provide a scholarly discussion of the literature around low-value health care and de-implementation, with the purpose of identifying implications for nursing research. With increasing pressures on the global nursing workforce, research identifying low-value health care and developing approaches to de-implement this care, is crucial.

Too Much Cancer Care?: Nurses' Perspectives on the Unnecessary Use of Oncology Services

BACKGROUND

"Unnecessary use of health services" refers to care that does not add value for patients and can lead to physical, emotional, and economical harm. High rates of overuse have been reported within oncology, and patients experience its consequences.

OBJECTIVE

The aim of this study was to explore perceptions and experiences of oncology nurses regarding unnecessary use of oncology services.

METHODS

In-depth, semistructured interviews were conducted with a convenience sample of 20 oncology nurses currently practicing in Israel. Interviews were recorded, transcribed, and analyzed thematically.

RESULTS

Themes included perceptions of unnecessary use of health services in cancer (causes and effects of unnecessary use, current and proposed solutions) and negative effects of unnecessary cancer care on patients, families, providers, and the system, including decreased quality of life, increased suffering, and emotional effects on patients and families. Causes were seen on provider, family, and patient levels, such as difficulty for providers to "give up," lack of registered nurses' authority, and family and patient demands. Multidisciplinary care provision, nurses' role, and the patient-provider relationship were seen as existing facilitators minimizing unnecessary use. Future improvement can be achieved by strengthening relationships, providing support to healthcare providers, and improving communication.

CONCLUSIONS

Nurses perceive unnecessary use of health services as a result of multiple, interlinked and complex causes, but few targeted interventions exist. Future research should explore quantifying unnecessary use to determine an accurate representation of the issue.

IMPLICATIONS FOR PRACTICE

Solutions should include engaging patients and families, involving nurses, and fostering multidisciplinary collaborative teamwork to positively affect care and treatment decision-making processes.

Community nurses and chronic disease in Israel: Professional dominance as a social justice issue

Chronic diseases are major causes of health inequalities. Community nurses can potentially make large contributions to chronic illness prevention and management in Israel but may be obstructed by professional dominance of physicians. However, insufficient research exists about community nursing in Israel, and how it may differ from other countries. This study aims to document chronic disease-related community nursing roles in Israel, identify changes and trends in community nursing roles that may increase social justice, and understand how the roles and trends in community health nursing in Israel may differ from developments in other countries. In-depth interviews were performed with 55 Israeli health system professionals, and 692 nurse care-givers were asked open-ended questions. Interview answers were analyzed to find themes and trends. The study found that community nurse roles in Israel have expanded, especially for chronic disease control. Commonalities exist with countries such as the United States and the UK, albeit with important differences. However, continued conflicts with physicians exist, which can limit nurses' contributions to reducing health inequalities. Community nurses' importance is growing. Enabling them to overcome professional dominance and improve chronic disease control can help reduce health inequalities in Israel and elsewhere.

Understanding the public's role in reducing low-value care: a scoping review

BACKGROUND

Low-value care initiatives are rapidly growing; however, it is not clear how members of the public should be involved. The objective of this scoping review was to systematically examine the literature describing public involvement in initatives to reduce low-value care.

METHODS

Evidence sources included MEDLINE, EMBASE, and CINAHL databases from inception to November 26, 2019, grey literature (CADTH Tool), reference lists of included articles, and expert consultation. Citations were screened in duplicate and included if they referred to the public's perception and/or involvement in reducing low-value care. Public included patients or citizens without any advanced healthcare knowledge. Low-value care included medical tests or treatments that lack efficacy, have risks that exceed benefit, or are not cost-effective. Extracted data pertained to study characteristics, low-value practice, clinical setting, and level of public involvement (i.e., patient-clinician interaction, research, or policy-making).

RESULTS

The 218 included citations were predominantly original research (n = 138, 63%), published since 2010 (n = 192, 88%), originating from North America (n = 146, 67%). Most citations focused on patient engagement within the patient-clinician interaction (n = 156, 72%), using tools that included shared decision-making (n = 66, 42%) and patient-targeted educational materials (n = 72, 46%), and reported both reductions in low-value care and improved patient perceptions regarding low-value care. Fewer citations examined public involvement in low-value care policy-making (n = 33, 15%). Among citations that examined perspectives regarding public involvement in initiatives to reduce low-value care (n = 10, 5%), there was consistent support for the utility of tools applied within the patient-clinician interaction and less consistent support for involvement in policy-making.

CONCLUSIONS

Efforts examining public involvement in low-value care concentrate within the patient-clinician interaction, wherein patient-oriented educational materials and shared decision-making tools have been commonly studied and are associated with reductions in low-value care. This contrasts with inclusion of the public in low-value care policy decisions wherein tools to promote engagement are less well-developed and involvement not consistently viewed as valuable.

TRIAL REGISTRATION

Open Science Framework (https://osf.io/6fsxm).