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Harris et al. (2014) summarised these challenges as being related to time, culture, professional reluctance and the fear of "getting it wrong".
Clinical inertia, patient and professional reluctance to intensify management, and, on occasion, lack of appropriate tools and knowledge all contribute to failure.
It is most unlikely that this represented cream-skimming; rather, a combination of professional reluctance to lose control and patient reluctance to change a familiar pattern of care.
This was particularly challenging, as a significant barrier to facilitating rigorous designs has been professional reluctance to refer into trials when there is a perception of change or withdrawal of service, regardless of the evidence base for the effectiveness of that service [ 25].
Centralisation of the cancer expertise within specialist centres and professional reluctance to treat patients away from the hospital primarily for safety concerns was cited by Pace et al (2009) as being the root cause of local opposition to their own efforts to undertake a study of community chemotherapy.
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Similarly, the invasive nature of colonoscopy is the main reason for professionals' reluctance.
This may be compounded by health care professionals' reluctance to initiate self-management discussions.
Health professionals' reluctance to engage with technology and media sources [ 28] may also contribute to this divide.
This points up the salience of previous findings about professionals' reluctance and patients' reticence to discuss depression in the context of LTCs [ 10].
The patients and family caregivers were aware of health professionals' reluctance to raise hopes and of the arguments about lack of evidence.
Lack of understanding of models may contribute to health professionals' reluctance to follow their recommendations [ 19], and this can apply to DAMs as well as other mathematical models.
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com