OBJECTIVE: To compare different wording approaches for conveying the strength of health care recommendations. STUDY DESIGN AND SETTING:Participants were medical residents in Canada and the United States. We randomized them to one of three wording approaches, each expressing two strengths of recommendation, strong and weak: (1) "we recommend," "we suggest;" (2) "clinicians should," "clinicians might;" (3) "we recommend," "we conditionally recommend." Each participant received one strong and one weak recommendation. For each recommendation, they chose a hypothetical course of action; we judged whether their choice was appropriate for the strength of the recommendation. RESULTS: The response rate was 77% (341/441). Most participants, in response to strong recommendations, chose hypothetical courses of action appropriate for weak recommendations. None of the wording approaches was clearly superior in conveying the strength of a recommendation. However, different approaches appeared superior depending on the strength and direction (for or against an intervention) of the recommendation. CONCLUSION: No wording approach was clearly superior in conveying the strength of recommendation. Guideline developers need to make the connection between the wording and their intended strength explicit.
RCT Entities:
OBJECTIVE: To compare different wording approaches for conveying the strength of health care recommendations. STUDY DESIGN AND SETTING:Participants were medical residents in Canada and the United States. We randomized them to one of three wording approaches, each expressing two strengths of recommendation, strong and weak: (1) "we recommend," "we suggest;" (2) "clinicians should," "clinicians might;" (3) "we recommend," "we conditionally recommend." Each participant received one strong and one weak recommendation. For each recommendation, they chose a hypothetical course of action; we judged whether their choice was appropriate for the strength of the recommendation. RESULTS: The response rate was 77% (341/441). Most participants, in response to strong recommendations, chose hypothetical courses of action appropriate for weak recommendations. None of the wording approaches was clearly superior in conveying the strength of a recommendation. However, different approaches appeared superior depending on the strength and direction (for or against an intervention) of the recommendation. CONCLUSION: No wording approach was clearly superior in conveying the strength of recommendation. Guideline developers need to make the connection between the wording and their intended strength explicit.
Authors: Rebecca L Morgan; Ivan Florez; Maicon Falavigna; Sergio Kowalski; Elie A Akl; Kristina A Thayer; Andrew Rooney; Holger J Schünemann Journal: Health Res Policy Syst Date: 2018-07-13
Authors: Roland B Büchter; Cornelia Betsch; Martina Ehrlich; Dennis Fechtelpeter; Ulrich Grouven; Sabine Keller; Regina Meuer; Constanze Rossmann; Andreas Waltering Journal: J Med Internet Res Date: 2020-08-10 Impact factor: 5.428