Therapeutic inertia in chronic diseases: a scoping review of definitions, measurement, aproaches and associated factors

Background: Therapeutic inertia is a well-recognized phenomenon in the management of chornic diseases and has been associated with suboptimal clinical outcomes. It is commonly defined as the failure to initiate or intensify treatment when clinically indicated. However, despite its relevance, there is considerable heterogeneity in how therapeutic inertia is defined, conceptualized and measured across studies. In addition, no standardized and validated instruments are currenttly available to assess therapeutic inertia at the professional level. Furthermore, therapeutic inertia is a complez and multifactorial phenomenon involving factors related to healthcare professionals, patients and healthcare system. There factors have been explored inconsistently in the literature, limiting a comprehensive understanding of the construct. Objective: The aim of this scoping review is to map the available evidence on the definition, conceptualization, measurement approaches and associated factors of therapeutic inertia in chronic diseases. Methods: A scoping review will be conducted following the PRISMA-ScR guidelines. A systematic search will be performed in PubMed/MEDLINE, Scopus and Web of Science. Studies addressing therapeutic inertia in the context of chronic diseases will be included, regardless of study design. Both quantitative and qualitative studies, as well as reviews, will be considered. Study selection will be conducted in three stages: removal of duplicates, screening of titles and abstracts, and full-text assessment. Two independent reviewers will perform the selection process, with disagreements resolved by consensus. Data extraction will include information on study characteristics, definitions of therapeutic inertia, measurement methods, and associated factors. Results will be synthesized using descriptive analysis and thematic analysis to identify key dimensions and gaps in the literature. Expected outcomes: This review will provide a comprehensive overview of how therapeutic inertia has been defined and measured, identify its main dimensions and associated factors, and highlight existing gaps. The findings will support the development of a standardized instrument to assess therapeutic inertia at the professional level.