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Table 2 Ten most frequently cited determinants of de-implementation from the systematic review mapped to relevant stakeholders

From: Determinants of the de-implementation of low-value care: a multi-method study

Stakeholders

Frequently Cited Barriers

Frequently Cited Facilitators

Patients

• Patient demands and preferences

•Challenges with stakeholder support

• Stakeholder involvement

• Shared decision-making

• Patient awareness of low-value care

Clinicians

• Lack of credible evidence

• Disconnect between training and evidence

• Fear of malpractice

• Entrenched norms and clinicians’ resistance to change

• Challenges with stakeholder support

• Model of physician reimbursement

• Stakeholder involvement

• Availability of credible evidence

• Shared decision-making

• Audit and feedback

• Interactive clinician education

• Clinical decision support

Decision-makers

• Lack of credible evidence

• Lack of resources for de-adoption initiatives

• Lack of data for identifying low-value care

• Challenges with stakeholder support

• Model of physician reimbursement

• Lack of criteria for identifying low-value practices

• Stakeholder involvement

• Availability of credible evidence

• Cost-saving opportunity

• Prioritized low-value practices

• Established and credible assessment criteria to identify low-value care

Researchers

• Lack of credible evidence

• Lack of resources for de-adoption initiatives

• Lack of data for identifying low-value care

• Challenges with stakeholder support

• Lack of criteria for identifying low-value practices

• Stakeholder involvement

• Availability of credible evidence

• Prioritized low-value practices

• Established and credible assessment criteria to identify low-value care