title: "Entrenched practices and other biases": unpacking the historical, economic, professional, and social resistance to de-implementation.
abstract: BACKGROUND
  In their article on "Evidence-based de-implementation for contradicted, unproven, and aspiring healthcare practices," Prasad and Ioannidis (IS 9:1, 2014) referred to extra-scientific "entrenched practices and other biases" that hinder evidence-based de-implementation.
  
  
  CONCLUSIONS
  Using the case example of the de-implementation of radical mastectomy, we disaggregated "entrenched practices and other biases" and analyzed the historical, economic, professional, and social forces that presented resistance to de-implementation. We found that these extra-scientific factors operated to sustain a commitment to radical mastectomy, even after the evidence slated the procedure for de-implementation, because the factors holding radical mastectomy in place were beyond the control of individual clinicians. We propose to expand de-implementation theory through the inclusion of extra-scientific factors. If the outcome to which we aim is appropriate and timely de-implementation, social scientific analysis will illuminate the context within which the healthcare practitioner practices and, in doing so, facilitate de-implementation by pointing to avenues that lead to systems change. The implications of our analysis lead us to contend that intervening in the broader context in which clinicians work--the social, political, and economic realms--rather than focusing on healthcare professionals' behavior, may indeed be a fruitful approach to effect change.
authors.affiliation: The Sophie Davis School of Biomedical Education, City University of New York, 160 Convent Avenue, New York, NY, 10031, USA. TMontini@med.cuny.edu.
authors.forename: Theresa
authors.initials: T
authors.lastname: Montini
authors.affiliation: School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, 451 Smyth Road, Ottawa, Ontario, K1H 8M5, Canada. igraham@ohri.ca.
authors.forename: Ian D
authors.initials: ID
authors.lastname: Graham
mesh_terms: D001943:Breast Neoplasms / Q000266:history* / Q000601:surgery / Q000628:therapy; D004059:Diffusion of Innovation; D019317:Evidence-Based Medicine / Q000191:economics / Q000266:history; D005260:Female; D049672:History, 19th Century; D049673:History, 20th Century; D006801:Humans; D008408:Mastectomy / Q000266:history*; D015409:Mastectomy, Radical / Q000266:history; D011057:Politics; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000266:history*; D012959:Socioeconomic Factors; D014481:United States