Table 4.

Representative quotes for tension between evidence-based practice and patient-centered care

Site	Quotes
A-HEBP/HPCC	“Always a tension between standardization of care based on evidence and allowing patient preferences to be respected. There are patients that for a variety of reasons don’t want certain elements of care that are medically necessary, but a fundamental element is the autonomy of patient decisions. Sometimes they decline care we think is best for them. Patient-centered care is somewhat a somewhat trendy term, even 20 years ago. What has changed in a last decades is the organization of services around needs of patient rather than staff.”
E-HEBP/LPCC	“I was involved in a situation, where a patient needed bypass surgery and a patient might have needed blood during the surgery, but the patient’s religious beliefs wouldn’t allow him to have it. So, we talked with him and got our team very involved, and ultimately it ended with the patient going to a different institution where they do bloodless surgery. We didn’t have capability to do a bloodless surgery here, so the patient transferred to an institution that could do the surgery and the VA paid.”
G-LEBP/HPCC	“We have an argument going on right now, we have a case of osteomyelitis and patient doesn’t want another 6 weeks of antibiotics through the IV and that’s for reasons that I understand because it’s this whole thing with his wife and everything. So, he doesn’t want it, he said he’d rather have his foot cut off. So now my team should be hopefully calling the vascular surgeon to have an amputation performed, which they probably won’t want to do but the patient really doesn’t want antibiotics again.”
K-LEBP/LPCC	“I would say it happens all the time when we, it’s for a specific condition, when we start blood thinning with patients with heart conditions. Talk about coumadin, warfarin for atrial fib. Tons of evidence to tell what is the best to prevent stroke I don’t think that that gets applied in consistent way and definitely not patient centered way. Use coumadin and difficult for patients to take and manage. I think that patients’ part in this gets lost. I think in our enthusiasm to provide EBC…Often times the discussion with the patient and what this means for your life is lacking. That has a major impact on compliance with the med. And down the road to readmission and complications about taking the med.“

Note. HEBP = high evidenced-based practice; LEBP = low evidence-based practice; HPCC = high patient-centered care; LPCC = low patient-centered care; VA = Veterans Affairs; IV = intravenous therapy; EBC = evidence-based care; atrial fib. = atrial fibrillation.