Ignacio Neumann1, Pablo Alonso-Coello2, Per Olav Vandvik3, Thomas Agoritsas4, Gemma Mas2, Elie A Akl5, Romina Brignardello-Petersen6, Jose Emparanza7, Lauren McCullagh8, Catherine De Sitio8, Thomas McGinn9, Hind Almodaimegh10, Khalid Almodaimegh11, Solange Rivera12, Luis Rojas13, Jérôme Stirnemann14, Jihad Irani15, Sani Hlais16, Reem Mustafa17, Fadi Bdair18, Abdelrahman Aly17, Annette Kristiansen19, Ariel Izcovich20, Anggie Ramirez21, Jan Brozek22, Gordon Guyatt22, Holger J Schünemann22. 1. Department of Internal Medicine, Pontificia Universidad Catolica de Chile, Alameda 340, Santiago 8331150, Chile. Electronic address: ignacio.neumann@gmail.com. 2. Centro Cochrane Iberoamericano, Instituto de Investigación Biomédica (CIBERESP-IIB Sant Pau), C/ Sant Antoni Maria Claret 167, Barcelona 08025, Spain. 3. Department of Medicine, Innlandet Hospital Trust-division Gjøvik, Kyrre Greppsgt.11, Gjøvik 2819, Norway. 4. Division of General Internal Medicine & Division of Clinical Epidemiology, University Hospitals of Geneva, Gabrielle-Perret-Gentil 4 Geneva 14 1211, Switzerland. 5. Department of Internal Medicine, American University of Beirut Medical Center, P.O. Box: 11-0236, Riad-El-Solh Beirut, Beirut 1107 2020, Lebanon. 6. Evidence-Based Dentistry Unit, Faculty of Dentistry, Universidad de Chile, Av Libertador Bernardo O'Higgins 1058, Santiago, Región Metropolitana 8330111, Chile. 7. Clinical Epidemiology Unit, (CASPe-CIBER-ESP), Donostia University Hospital, Paseo Doctor Beriguistain 109, San Sebastian 20014, Spain. 8. Department of Medicine, North Shore-LIJ Health System, 600 Community Drive, Suite 300, Manhasset 11030, NY, USA. 9. Medicine Service Line Northwell Health, 300 Community Drive, Manhasset 11030, NY, USA. 10. College of Pharmacy-Female Branch, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, PO BOX 22490, Riyadh 11426, Saudi Arabia. 11. Family Medicine and Diabetology, Al-Iman Hospital, Riyadh 11544, Saudi Arabia. 12. Department of Family Medicine, Pontificia Universidad Catolica de Chile, Alameda 340, Santiago 8331150, Chile. 13. Department of Internal Medicine, Pontificia Universidad Catolica de Chile, Alameda 340, Santiago 8331150, Chile. 14. Department of General Internal Medicine, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, Geneva CH-1211, Switzerland. 15. University of Balamand, Faculty of Medicine & Medical Sciences, Beirut, Lebanon. 16. Family Medicine Departments, American University of Beirut and Saint Joseph University, Beirut, Lebanon. 17. University of Missouri-Kansas City School of Medicine, M4-303 2411 Holmes St., Kansas City 64108-2792, MO, USA. 18. Mosaic Life Care, 011 E St Maartens Dr, St Joseph 64506, MO, USA. 19. Department of Internal Medicine, Sykehuset Innlandet Hospital Trust, Gjøvik, Norway; Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway. 20. Department of Internal Medicine, Hospital Alemán, Pueyrredón 1640, Buenos Aires C1118AAT, Argentina. 21. International Health Central American Institute Foundation & Cochrane Central America & Spanish Caribbean Branch of the Iberoamerican Cochrane Centre, San Jose, Costa Rica Costa Rica, San José, Santa Ana, Condominio Santa Ana Hills #43, San Jose Zip Code: 10-901, Costa Rica. 22. Department of Clinical Epidemiology and Biostatistics and Department of Medicine, McMaster University, Main Street West 1200, Hamilton L8S4L8, Ontario, Canada.
Abstract
OBJECTIVES: Evidence-based clinical practice guidelines provide recommendations to assist clinicians in decision-making and to reduce the gap between best current research evidence and clinical practice. However, some argue that providing preappraised evidence summaries alone, rather than recommendations, is more appropriate. The objective of the study is to evaluate clinicians' preferences, and understanding of the evidence and intended course of action in response to evidence summaries with and without recommendations. STUDY DESIGN SETTING: We included practicing clinicians attending educational sessions across 10 countries. Clinicians were randomized to receive relevant clinical scenarios supported by research evidence of low or very low certainty and accompanied by either strong or weak recommendations developed with the GRADE system. Within each group, participants were further randomized to receive the recommendation plus the corresponding evidence summary or the evidence summary alone. We evaluated participants' preferences and understanding for the presentation strategy, as well as their intended course of action. RESULTS:One hundred eighty-nine of 219 (86%) and 201 of 248 (81%) participants preferred having recommendations accompanying evidence summaries for both strong and weak recommendations, respectively. Across all scenarios, less than half of participants correctly interpreted information provided in the evidences summaries (e.g., estimates of effect, certainty in the research evidence). The presence of a recommendation resulted in a more appropriate intended course of action for two scenarios involving strong recommendations. CONCLUSION: Evidence summaries alone are not enough to impact clinicians' course of action. Clinicians clearly prefer having recommendations accompanying evidence summaries in the context of low or very low certainty of evidence (Trial registration NCT02006017).
RCT Entities:
OBJECTIVES: Evidence-based clinical practice guidelines provide recommendations to assist clinicians in decision-making and to reduce the gap between best current research evidence and clinical practice. However, some argue that providing preappraised evidence summaries alone, rather than recommendations, is more appropriate. The objective of the study is to evaluate clinicians' preferences, and understanding of the evidence and intended course of action in response to evidence summaries with and without recommendations. STUDY DESIGN SETTING: We included practicing clinicians attending educational sessions across 10 countries. Clinicians were randomized to receive relevant clinical scenarios supported by research evidence of low or very low certainty and accompanied by either strong or weak recommendations developed with the GRADE system. Within each group, participants were further randomized to receive the recommendation plus the corresponding evidence summary or the evidence summary alone. We evaluated participants' preferences and understanding for the presentation strategy, as well as their intended course of action. RESULTS: One hundred eighty-nine of 219 (86%) and 201 of 248 (81%) participants preferred having recommendations accompanying evidence summaries for both strong and weak recommendations, respectively. Across all scenarios, less than half of participants correctly interpreted information provided in the evidences summaries (e.g., estimates of effect, certainty in the research evidence). The presence of a recommendation resulted in a more appropriate intended course of action for two scenarios involving strong recommendations. CONCLUSION: Evidence summaries alone are not enough to impact clinicians' course of action. Clinicians clearly prefer having recommendations accompanying evidence summaries in the context of low or very low certainty of evidence (Trial registration NCT02006017).
Authors: Patricia L Kavanagh; Francine Frater; Tamara Navarro; Peter LaVita; Rick Parrish; Alfonso Iorio Journal: J Am Med Inform Assoc Date: 2021-03-18 Impact factor: 4.497
Authors: Thomas W L Scheeren; Jan Bakker; Thomas Kaufmann; Djillali Annane; Pierre Asfar; E Christiaan Boerma; Maurizio Cecconi; Michelle S Chew; Bernard Cholley; Maria Cronhjort; Daniel De Backer; Arnaldo Dubin; Martin W Dünser; Jacques Duranteau; Anthony C Gordon; Ludhmila A Hajjar; Olfa Hamzaoui; Glenn Hernandez; Vanina Kanoore Edul; Geert Koster; Giovanni Landoni; Marc Leone; Bruno Levy; Claude Martin; Alexandre Mebazaa; Xavier Monnet; Andrea Morelli; Didier Payen; Rupert M Pearse; Michael R Pinsky; Peter Radermacher; Daniel A Reuter; Yasser Sakr; Michael Sander; Bernd Saugel; Mervyn Singer; Pierre Squara; Antoine Vieillard-Baron; Philippe Vignon; Jean-Louis Vincent; Iwan C C van der Horst; Simon T Vistisen; Jean-Louis Teboul Journal: Ann Intensive Care Date: 2021-01-29 Impact factor: 6.925