Table 2 Barriers for CPath use in clinical practice mentioned in ≥2 interviews (n = 29).
Innovation factors | No of interviews (n = 16) | Individual health professional factors | No of interviews (n = 16) | Incentives and resources | No of interviews (n = 16) | Social, political and legal factors | No of interviews (n = 16) |
|---|---|---|---|---|---|---|---|
Compatibility | Agreement with recommendation | Availability of necessary resources | Legislation | ||||
• Vulnerability of CPath depending on quality of previous steps workflow | 3 | • Critical attitude towards CPath clinical use | 9 | • Insufficient staining quality | 2 | • Liability position/responsibility of pathologists regarding CPath output | 7 |
• Unavailability of digital workflow | 2 | • Unclearness regarding liability in case of error CPath | 3 | ||||
• Unawareness regarding applicable regulations CPath use | 3 | ||||||
Feasibility | Awareness and familiarity | Financial (dis)incentives | |||||
• More difficult to develop CPath for rare cancer types | 2 | • Perception of CPath being a “black-box” | 6 | • Tremendous financial investment | 3 | ||
• Time associated with CPath implementation process | 2 | • Limited knowledge regarding CPath | 5 | • Relative small budget pathology departments | 2 | ||
• Effort to guide CPath before and after tissue analysis | 2 | • Lack of experience regarding CPath | 4 | ||||
• Hard to imagine specific leading role of CPath within workflow | 2 | ||||||
Quality of evidence | Expected outcome | ||||||
• Questionable reliability of CPath | 4 | • Potential clinical impact of rather minor deviations CPath (e.g. Gleason grading) | 2 | ||||
• Problems regarding determination ground truth | 4 | • Potential clinical impact of accepted error margins CPath | 2 | ||||
• Questionable improvement in clinical practice due to CPath | 3 | ||||||
• Hard to determine cause-effect relationship between CPath use and clinical outcomes | 4 | ||||||
• Time associated with prospective clinical trials | 5 | ||||||
• Uncertainty regarding CPath validation on local level | 5 | ||||||
Source of the recommendation | Domain knowledge | ||||||
• Potential conflict of interest CPath suppliers | 2 | • Loss of domain knowledge due to CPath | 2 | ||||
Emotions | |||||||
• Fear of losing job | 4 | ||||||
Skills needed to adhere | |||||||
• Loss of diagnostic skills | 7 | ||||||
• Becoming too reliant on CPath | 4 | ||||||
