title: Thou shalt versus thou shalt not: a meta-synthesis of GPs' attitudes to clinical practice guidelines.
abstract: BACKGROUND
  GPs' adherence to clinical practice guidelines is variable. Barriers to guideline implementation have been identified but qualitative studies have not been synthesised to explore what underpins these attitudes.
  
  
  OBJECTIVE
  To explore and synthesise qualitative research on GPs' attitudes to and experiences with clinical practice guidelines.
  
  
  METHODS
  Systematic review and meta-synthesis of qualitative studies.
  
  
  METHODS
  PubMed, CINAHL, EMBASE, Social Science Citation Index, and Science Citation Index were used as data sources, and independent data extraction was carried out. Discrepancies were resolved by consensus. Initial thematic analysis was conducted, followed by interpretative synthesis.
  
  
  RESULTS
  Seventeen studies met the inclusion criteria. Five were excluded following quality appraisal. Twelve papers were synthesised which reported research in the UK, US, Canada, and the Netherlands, and covered different clinical guideline topics. Six themes were identified: questioning the guidelines, GPs' experience, preserving the doctor-patient relationship, professional responsibility, practical issues, and guideline format. Comparative analysis and synthesis revealed that GPs' reasons for not following guidelines differed according to whether the guideline in question was prescriptive, in that it encouraged a certain type of behaviour or treatment, or proscriptive, in that it discouraged certain treatments or behaviours.
  
  
  CONCLUSIONS
  Previous analyses of guidelines have focused on professional attitudes and organisational barriers to adherence. This synthesis suggests that the purpose of the guideline, whether its aims are prescriptive or proscriptive, may influence if and how guidelines are received and implemented.
authors.affiliation: Stein Rokkan Centre for Social Studies, University of Bergen, Bergen, Norway. benedicte.carlsen@rokkan.uib.no
authors.forename: Benedicte
authors.initials: B
authors.lastname: Carlsen
authors.forename: Claire
authors.initials: C
authors.lastname: Glenton
authors.forename: Catherine
authors.initials: C
authors.lastname: Pope
mesh_terms: D001291:Attitude of Health Personnel; D005194:Family Practice; D019983:Guideline Adherence; D006801:Humans; D010817:Physician-Patient Relations; D017410:Practice Guidelines as Topic; D011364:Professional Practice; D036301:Qualitative Research