A systematic review of the clinician related barriers and facilitators to the use of evidence-informed interventions for post traumatic stress

Background: A number of evidence-informed interventions for PTSD have been developed and recommended by clinical guidelines. Despite efforts to disseminate these approaches, there remains a gap between evidence and practice, and research has started to identify a number of barriers to the implementation of evidence-informed interventions. Methods: This systematic review aimed to synthesise the relevant literature, both quantitative and qualitative, relating to clinicians' perceived barriers and facilitators. Literature searches were conducted to identify relevant studies. Data were analysed using content analysis to categorise key barriers and facilitators. Results: A literature search identified 34 relevant studies. Four levels of barriers and facilitators were identified, covering intervention, client, clinician and system factors. The most commonly cited barriers identified include inflexibility of manualised approaches, fear of increasing client distress, working with comorbidities and a lack of training and support. Quality appraisal rated the majority of studies as strong, with five studies receiving an adequate rating. Limitations: The review was limited to studies published in the English language, therefore introducing a risk of bias as perceived barriers and facilitators may be culturally influenced. Additionally the heterogeneity of studies may impact upon comparability, only allowing for a broad analysis and not exploring barriers and facilitators in more detail. Conclusions: Lack of training, confidence and knowledge relating to the implementation of evidence-informed interventions for PTSD were commonly reported. A better-informed understanding into the challenges and facilitators experienced by clinicians can help inform implementation needs and should be considered in the development and implementation of training initiatives.