# Challenging Encounters: A Systematic Scoping Review to Understand Patients' Influence on GPs' Compliance With Imaging Guidelines

## TL;DR

This paper explores how patient requests for diagnostic imaging challenge GPs' adherence to guidelines and highlights strategies to balance patient-centered care with evidence-based practices.

## Contribution

The study systematically identifies challenges and strategies GPs use when managing patient requests for imaging, emphasizing the need for interdisciplinary communication and policy changes.

## Key findings

- Patient expectations and anxiety often conflict with evidence-based imaging practices.
- GPs use trust-building and decision aids to manage patient requests.
- Economic incentives and institutional pressures hinder guideline compliance.

## Abstract

The shift in healthcare from paternalistic to patient‐centred care has led patients to actively engage in their own health journeys. As gatekeepers, General practitioners (GPs) face growing pressure from patients who, having accessed online health information, request diagnostic imaging, often contrary to established clinical guidelines.

This review explores the dynamic interactions among patients, GPs, and the broader healthcare system, offering insights into how to balance patient‐centred and value‐based care. The research specifically asked: what challenges do GPs face when responding to patient requests, and how do these challenges hinder adherence to guidelines on appropriate imaging? It also investigated what evidence‐based strategies GPs use to address patient requests and what support they receive in implementing guidelines and managing requests for imaging.

The systematic scoping review was conducted according to the Joanna Briggs Institute's guidelines and reported in accordance with PRISMA‐ScR. Embase, Medline, Scopus, CINAHL, and Web of Science were searched for published peer‐reviewed articles.

Of 2137 potential papers, 11 studies met the inclusion criteria and revealed that patient expectations, anxiety, low health literacy, medico‐legal concerns, reliance on imaging capabilities, and institutional incentives for GPs often conflicted with evidence‐based imaging practices. GPs utilised strategies such as patient‐centred trust‐building, clinical expertise, and decision aids to address these challenges. A quality assessment of the papers revealed that most studies were of moderate quality, with Hoy's risk of bias tool used for quantitative papers and the CASP analysis for qualitative papers.

This scoping review provided an understanding of the challenges encountered by GPs in addressing patient requests for imaging, underscoring the significance of patient‐centred care as being pivotal in nurturing a therapeutic patient‐GP rapport. Imaging is crucial for reducing diagnostic uncertainty and litigation; however, barriers such as economic incentives are present. Having interdisciplinary communication encourages guideline compliance. Implementing ongoing GP education, restructuring reimbursements and improving imaging accessibility can provide patients with a better understanding and purpose of the requested diagnostic imaging.