Do clinicians want recommendations? A multicenter study comparing evidence summaries with and without GRADE recommendations
Por:
Neumann, I, Alonso-Coello, P, Vandvik, PO, Agoritsas, T, Mas, G, Akl, EA, Brignardello-Petersen, R, Emparanza, J, McCullagh, L, De Sitio, C, McGinn, T, Almodaimegh, H, Almodaimegh, K, Rivera, S, Rojas, L, Stirnemann, J, Irani, J, Hlais, S, Mustafa, R, Bdair, F, Aly, A, Kristiansen, A, Izcovich, A, Ramirez, A, Brozek, J, Guyatt, G, Schunemann, HJ
Publicada:
1 jul 2018
Resumen:
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. (C) 2018 Elsevier Inc. All rights reserved.
Filiaciones:
Neumann, I:
Pontificia Univ Catolica Chile, Dept Internal Med, Alameda 340, Santiago 8331150, Chile
Alonso-Coello, P:
Inst Invest Biomed CIBERESP IIB St Pau, Ctr Cochrane Iberoamer, C St Antoni Maria Claret 167, Barcelona 08025, Spain
Vandvik, PO:
Innlandet Hosp Trust, Dept Med, Div Gjovik, Kyrre Greppsgt 11, N-2819 Gjovik, Norway
Agoritsas, T:
Univ Hosp Geneva, Div Gen Internal Med, Gabrielle Perret Gentil 4, CH-1211 Geneva 14, Switzerland
Univ Hosp Geneva, Div Clin Epidemiol, Gabrielle Perret Gentil 4, CH-1211 Geneva 14, Switzerland
Mas, G:
Inst Invest Biomed CIBERESP IIB St Pau, Ctr Cochrane Iberoamer, C St Antoni Maria Claret 167, Barcelona 08025, Spain
Akl, EA:
Amer Univ Beirut, Med Ctr, Dept Internal Med, POB 11-0236, Beirut 11072020, Lebanon
Brignardello-Petersen, R:
Univ Chile, Fac Dent, Evidence Based Dent Unit, Ave Libertador Bernardo OHiggins 1058, Santiago 8330111, Region Metropol, Chile
Emparanza, J:
Donostia Univ Hosp, Clin Epidemiol Unit, CASPe CIBER ESP, Paseo Doctor Beriguistain 109, San Sebastian 20014, Spain
McCullagh, L:
North Shore LIJ Hlth Syst, Dept Med, 600 Community Dr,Suite 300, Manhasset, NY 11030 USA
De Sitio, C:
North Shore LIJ Hlth Syst, Dept Med, 600 Community Dr,Suite 300, Manhasset, NY 11030 USA
McGinn, T:
Med Serv Line Northwell Hlth, 300 Community Dr, Manhasset, NY 11030 USA
Almodaimegh, H:
King Saud Bin Abdulaziz Univ Hlth Sci, King Abdulaziz Med City, Coll Pharm, Female Branch, POB 22490, Riyadh 11426, Saudi Arabia
Almodaimegh, K:
Al Iman Hosp, Family Med & Diabetol, Riyadh 11544, Saudi Arabia
Rivera, S:
Pontificia Univ Catolica Chile, Dept Family Med, Alameda 340, Santiago 8331150, Chile
Rojas, L:
Pontificia Univ Catolica Chile, Dept Internal Med, Alameda 340, Santiago 8331150, Chile
Stirnemann, J:
Geneva Univ Hosp, Dept Gen Internal Med, Rue Gabrielle Perret Gentil 4, CH-1211 Geneva, Switzerland
Irani, J:
Univ Balamand, Fac Med & Med Sci, Beirut, Lebanon
Hlais, S:
Amer Univ Beirut, Dept Family Med, Beirut, Lebanon
St Joseph Univ, Beirut, Lebanon
Mustafa, R:
Univ Missouri, Sch Med, M4-303 2411 Holmes St, Kansas City, MO 64108 USA
Bdair, F:
Mosa Life Care, 011 E St Maartens Dr, St Joseph, MO 64506 USA
Aly, A:
Univ Missouri, Sch Med, M4-303 2411 Holmes St, Kansas City, MO 64108 USA
Kristiansen, A:
Sykehuset Innlandet Hosp Trust, Dept Internal Med, Gjovik, Norway
Univ Oslo, Inst Hlth & Soc, Fac Med, Oslo, Norway
Izcovich, A:
Hosp Aleman, Dept Internal Med, Pueyrredon 1640,C1118AAT, Buenos Aires, DF, Argentina
Ramirez, A:
Int Hlth Cent Amer Inst Fdn, Condominio Santa Ana Hills 43, San Jose 10901, Costa Rica
Iberoamer Cochrane Ctr, Cochrane Cent Amer & Spanish Caribbean Branch, Condominio Santa Ana Hills 43, San Jose 10901, Costa Rica
Brozek, J:
McMaster Univ, Dept Clin Epidemiol & Biostat, Main St West 1200, Hamilton, ON L8S 4L8, Canada
McMaster Univ, Dept Med, Main St West 1200, Hamilton, ON L8S 4L8, Canada
Guyatt, G:
McMaster Univ, Dept Clin Epidemiol & Biostat, Main St West 1200, Hamilton, ON L8S 4L8, Canada
McMaster Univ, Dept Med, Main St West 1200, Hamilton, ON L8S 4L8, Canada
Schunemann, HJ:
McMaster Univ, Dept Clin Epidemiol & Biostat, Main St West 1200, Hamilton, ON L8S 4L8, Canada
McMaster Univ, Dept Med, Main St West 1200, Hamilton, ON L8S 4L8, Canada
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