title: A qualitative study on barriers to evidence-based practice in patient counseling and advocacy in Germany.
abstract: BACKGROUND
  Despite the attempt to integrate evidence-based practice (EBP) in patient counseling and advocacy, there is limited knowledge on the status quo of this process in the German health care system. Our objective was to identify important determinants influencing the application of EBP in the counseling and advocacy setting in Germany.
  
  
  METHODS
  We carried out a qualitative study performing semi-structured expert interviews and one group discussion among n = 9 patient counselors (PCs) and patient advocates (PAs) identified via expert recommendations and by contacting relevant institutions. The interview manual was developed on the basis of a literature review on barriers/facilitators of EBP in health care delivery and a preamble oriented pyramid discussion with a multidisciplinary team. Interviews were analyzed using the Grounded Theory method. A paradigm was developed to present the interrelations between hindering and facilitating factors for EBP and the attitude towards the utilization of EBP among PAs and PCs.
  
  
  RESULTS
  Findings from nine face-to-face interviews and one group discussion demonstrate that by now PCs and PAs do not recognize EBP as a tool to facilitate the professionalization of patient counselors and advocates. This result is due to individual and institutional barriers such as cognitive-behavioral, professional, attitude related as well as resource and system barriers. PCs and PAs have predominantly critical attitudes towards EBP caused by a lack of trust in its reliability and by concerns regarding unfavorable effects EBP may have on the relationship with the patient and on the cooperation with physicians. A missing infrastructure of needs-based EBP training programs also discourages PCs and PAs from engaging in EBP. Despite the numerous hindering factors, there is also a growing awareness that EBP could help to improve patient counseling and advocacy. To facilitate EBP in future, needs-based training programs and health policy interventions that support interdisciplinary collaboration are required.
  
  
  CONCLUSIONS
  Although EBP among PCs and PAs is gaining importance, it is still less likely to be recognized as helpful and its application faces various barriers. More needs-based EBP training programs and health policy interventions to decrease barriers and foster interdisciplinary collaboration are necessary.
authors.affiliation: Institute for Health Economics and Clinical Epidemiology, University Hospital of Cologne, Gleueler Str. 176-178, 50935, Köln, Germany. sibel.altin@uk-koeln.de.
authors.forename: Sibel
authors.initials: S
authors.lastname: Altin
authors.affiliation: Federal Joint Committee (G-BA), Wegelystr. 8, D-10623, Berlin, Germany. ampasson@gmail.com.
authors.forename: Anna
authors.initials: A
authors.lastname: Passon
authors.affiliation: Institute for Health Economics and Clinical Epidemiology, University Hospital of Cologne, Gleueler Str. 176-178, 50935, Köln, Germany. sibylle.kautz-freimuth@uk-koeln.de.
authors.forename: Sibylle
authors.initials: S
authors.lastname: Kautz-Freimuth
authors.affiliation: Faculty for Health Sciences, University of Witten Herdecke, Center for Integrative Medicine, Gerhard Kienle Institute for Medical Theory, Integrative and Anthroposophic Medicine, Gerhard Kienle Weg 4, D-58313, Herdecke, Germany. bettina.berger@uni-wh.de.
authors.forename: Bettina
authors.initials: B
authors.lastname: Berger
authors.affiliation: Institute for Health Economics and Clinical Epidemiology, University Hospital of Cologne, Gleueler Str. 176-178, 50935, Köln, Germany. stephanie.stock@uk-koeln.de.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Stock
mesh_terms: D001290:Attitude; D003376:Counseling; D004059:Diffusion of Innovation; D055317:Evidence-Based Practice; D005858:Germany; D006301:Health Services Needs and Demand; D007407:Interviews as Topic; D010344:Patient Advocacy; D036301:Qualitative Research; D015203:Reproducibility of Results