Developing and evaluating communication strategies to support informed decisions and practice based on evidence (DECIDE): protocol and preliminary results

Implementation Science

Pablo Alonso-Coello^1,10  Per Olav Vandvik⁹  Judith Thornton¹  Sarah Rosenbaum⁹  Holger J Schünemann⁷  Helena Liira^1,11  Alessandro Liberati⁴  Suzanne Hill³  Robin Harbour⁸  Signe Flottorp⁹  Marina Davoli²  Jan Brożek⁷  Linn Brandt⁹  Patrick M Bossuyt⁵  Philip Alderson¹  Andrew D Oxman⁹  Shaun Treweek⁶ 

[1] National Institute for Health and Clinical Excellence, Level 1A, City Tower, Piccadilly Plaza, Manchester, M1, 4BT, UK;Department of Epidemiology, Lazio Regional Health Service, Italian Cochrane Network, Via di Santa Costanza, 53, Rome, 00198, Italy;Australian National University, Canberra, Australia;The Italian Cochrane Centre, 14/D, Milan, Italy;Academic Medical Centre of the University of Amsterdam, Meibergdreef 91105 AZ, Amsterdam, The Netherlands;Population Health Sciences, University of Dundee, Kirsty Semple Way, Dundee, DD2 4BF, UK;McMaster University Health Sciences Centre, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada;Scottish Intercollegiate Guidelines Network Delta House, 50 West Nile Street, Glasgow, G1 2NP, UK;Norwegian Knowledge Centre for the Health Services, Postboks 7004 St Olavs plass, Oslo, 0130, Norway;Iberoamerican Cochrane Center, Biomedical Research Institute Sant Pau (IIB-Sant Pau), Sant Antoni María Claret 171, Barcelona, 08041, Spain;The Finnish Medical Society Duodecim, PO Box 713, Kalevankatu 11 AFIN-00101, Helsinki, Finland

关键词: Presentation formats;    Communication;    Recommendations;    Guidelines;   

Others  :  813831
DOI  :  10.1186/1748-5908-8-6

 received in 2012-10-24, accepted in 2012-12-19,  发布年份 2013

【 摘 要 】

Background

Healthcare decision makers face challenges when using guidelines, including understanding the quality of the evidence or the values and preferences upon which recommendations are made, which are often not clear.

Methods

GRADE is a systematic approach towards assessing the quality of evidence and the strength of recommendations in healthcare. GRADE also gives advice on how to go from evidence to decisions. It has been developed to address the weaknesses of other grading systems and is now widely used internationally. The Developing and Evaluating Communication Strategies to Support Informed Decisions and Practice Based on Evidence (DECIDE) consortium (http://www.decide-collaboration.eu/ webcite), which includes members of the GRADE Working Group and other partners, will explore methods to ensure effective communication of evidence-based recommendations targeted at key stakeholders: healthcare professionals, policymakers, and managers, as well as patients and the general public. Surveys and interviews with guideline producers and other stakeholders will explore how presentation of the evidence could be improved to better meet their information needs. We will collect further stakeholder input from advisory groups, via consultations and user testing; this will be done across a wide range of healthcare systems in Europe, North America, and other countries. Targeted communication strategies will be developed, evaluated in randomized trials, refined, and assessed during the development of real guidelines.

Discussion

Results of the DECIDE project will improve the communication of evidence-based healthcare recommendations. Building on the work of the GRADE Working Group, DECIDE will develop and evaluate methods that address communication needs of guideline users. The project will produce strategies for communicating recommendations that have been rigorously evaluated in diverse settings, and it will support the transfer of research into practice in healthcare systems globally.

【 授权许可】

   
2013 Treweek et al.; licensee BioMed Central Ltd.

【 图 表 】

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【 参考文献 】

• [1]Poolman RW, Sierevelt IN, Farrokhyar F, Mazel JA, Blankevoort L, Bhandari M: Perceptions and competence in evidence-based medicine: are surgeons getting better? a questionnaire survey of members of the Dutch orthopaedic association. J Bone Joint Surg Br 2007, 89:206-215.
• [2]Coleman P, Nicholl J: Influence of evidence-based guidance on health policy and clinical practice in England. Qual Saf Health Care 2001, 10:229-237.
• [3]De Vito C, Nobile CG, Furnari G, Pavia M, De Giusti M, Angelillo IF, Villari P: Physicians’ knowledge, attitudes and professional use of RCTs and meta-analyses: a cross-sectional survey. Eur J Public Health 2009, 19:297-302.
• [4]World Health Assembly. Resolution on health research. 2005. http://www.who.int/rpc/meetings/58th_WHA_resolution.pdf webcite
• [5]Domenighetti G, Grilli R, Liberati A: Promoting consumers' demand for evidence-based medicine. Int J Technol Assess Health Care 1998, 14:97-105.
• [6]Domenighetti G, Grilli R, Maggi JR: Does provision of an evidence-based information change public willingness to accept screening tests? Expectations 2000, 3:145-150.
• [7]Grol R, Grimshaw J: From best evidence to best practice; about effective implementation of change in patient care. Lancet 2003, 362:1225-1230.
• [8]McGlynn EA, Asch SM, Adams J, Keesey J, Hicks J, DeCristofaro A, Kerr EA: The quality of health care delivered to adults in the United States. N Engl J Med 2003, 348:2635-2645.
• [9]Grimshaw JM, Shirran L, Thomas R, Mowatt G, Fraser C, Bero L, Grilli R, Harvey E, Oxman AD, O'Brien M: Changing provider behavior: An overview of systematic reviews of interventions. Medical Care 2001, 39(3):II-2-II-45.
• [10]Grimshaw JM, Thomas RE, MacLennan G, Fraser C, Ramsay C, Vale L, Whitty P, Eccles MP, Matowe L, Shirran L, Wensing M, Dijkstra R, Donaldson C: Effectiveness and efficiency of guideline communication and implementation strategies. Health Technol Assess 2004, 8:1-72.
• [11]Oxman AD, Glasziou P, Williams JW: What should clinicians do when faced with conflicting recommendations? BMJ 2008, 337:a2530.
• [12]Shekelle PG, Kravitz RL, Beart J, Marger M, Wang M, Lee M: Are nonspecific practice guidelines potentially harmful? A randomized comparison of the effect of nonspecific versus specific guidelines on physician decision making. Health Serv Res 2000, 34:1429-1448.
• [13]Lohr KN, Field MJ: Guidelines for clinical practice. From development to use. Washington D.C: National Academy Press; 1992.
• [14]GRADE Working Group: Grading quality of evidence and strength of recommendations. BMJ 2004, 328:1490.
• [15]GRADE Working Group: Systems for grading the quality of evidence and the strength of recommendations I: Critical appraisal of existing approaches. BMC Health Serv Res 2004, 4:38. BioMed Central Full Text
• [16]Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, Schünemann HJ, and the GRADE Working Group: GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 2008, 336:924-926.
• [17]GRADE Working Group: Organizations that have endorsed or that are using GRADE. http://www.gradeworkinggroup.org/society/index.htm webcite
• [18]Ansari MT, Tsertsvadze A, Moher D: Grading quality of evidence and strength of recommendations: a perspective. PLoS Med 2009, 6:e1000151.
• [19]Calonge N: New promise for uniform evidence-based guideline development: the GRADE approach. National Guideline Clearing House Expert Commentaries. 2009. http://www.guideline.gov/expert/expert-commentary.aspx?id=16440&search=grade+and+promise webcite
• [20]Owens DK, Lohr KN, Atkins D, Treadwell JR, Reston JT, Bass EB, Chang S, Helfand M: Grading the strength of a body of evidence when comparing medical interventions. Agency for Healthcare Research and Quality and the Effective Health Care Program. J Clin Epidemiol 2010, 63:513-523.
• [21]Rosenbaum SE, Glenton C, Nylund HK, Oxman AD: User testing and stakeholder feedback contributed to the development of understandable and useful Summary of Findings tables for Cochrane reviews. J Clin Epidemiol 2010, 63:607-619.
• [22]Rosenbaum SE, Glenton C, Oxman AD: Summary of Findings tables improved understanding and rapid retrieval of key information in Cochrane Reviews. J Clin Epidemiol 2010, 63:620-626.
• [23]SUPPORT Collaboration: SUPPORT structured summaries of systematic reviews. http://www.support-collaboration.org/summaries.htm webcite
• [24]Rosenbaum SE, Glenton C, Wiysonge C, Abalos E, Mignini L, Young T, Althabe F, Ciapponi A, Marti SG, Meng Q, Wang J, la Hoz Bradford AM, Kiwanuka SN, Rutebemberwa E, Pariyo GW, Flottorp S, Oxman AD: Evidence summaries tailored for health policymakers in low and middle-income countries. Bull World Health Org 2011, 89:54-61.
• [25]Glenton C, Underland V, Kho M, Oxman AD: Summaries of findings, descriptions of interventions, and information about adverse effects would make reviews more informative. J Clin Epidemiol 2006, 59:770-778.
• [26]Akl EA, Maroun N, Guyatt G, Oxman AD, Alonso-Coello PA, Vist GE, Devereaux PJ, Montori VM, Schünemann HJ: Symbols were superior to numbers for presenting strength of recommendations to health care consumers: a randomized trial. J Clin Epidemiol 2007, 60:1298-1305.
• [27]Santesso N, Glenton C, Rader T, Strømme Nilsen E, Moja L, Pardo J, et al.: A new format for plain language summaries: does it improve understanding, and is it useful and preferable?. Singapore: 8th Cochrane Colloquium; 2009.
• [28]Vandvik PO, Santesso N, Akl EA, You J, Mulla S, Spencer FA, Johnston BC, Brozek J, Kreis J, Brandt L, Zhou Q, Schünemann HJ, Guyatt G: Formatting modifications in GRADE evidence profiles improved guideline panelists comprehension and accessibility to information. A randomized trial. J Clin Epidemiol 2012, 65:748-755.
• [29]Schünemann HJ, Oxman AD, Brozek J, Glasziou P, Jaeschke R, Vist GE, Kunz R, Williams J, Craig J, Montori V, Bossuyt P, Guyatt GH, and the GRADE Working Group: Grading the quality of evidence and strength of recommendations for diagnostic tests and strategies. BMJ 2008, 336:106-110.
• [30]Gagliardi AR, Brouwers MC, Palda VA, Lemieux-Charles L, Grimshaw JM: How can we improve guideline use? A conceptual framework of implementability. Implement Sci 2011, 6:26. BioMed Central Full Text
• [31]Schünemann HJ, Oxman AD, Vist GE, Higgins JPT, Glasziou P, Guyatt GH: Presenting results and ‘summary of findings’ tables. Chapter 11. In Cochrane handbook for systematic reviews of interventions. Edited by Higgins JPT, Green S. Chichester (UK): Wiley-Blackwell; 2008.
• [32]Schünemann HJ, Oxman AD, Vist GE, Higgins JPT, Deeks JJ, Glasziou P, Guyatt GH: Interpreting results and drawing conclusions. Chapter 12. In Cochrane Handbook for Systematic Reviews of Interventions. Edited by Higgins JPT, Green S. Chichester: Wiley-Blackwell; 2008.
• [33]Morville P: User Experience Design. Sematic Studios LLC. 2004. http://www.semanticstudios.com/publications/semantics/000029.php webcite
• [34]Rosenbaum SE: Improving the user experience of evidence. A design approach to evidence-informed health care. Oslo: Oslo College of Architecture and Design; 2010:108-116.
• [35]Treweek S, Ricketts IW, Francis J, Eccles M, Bonetti D, Pitts NB, MacLennan G, Sullivan F, Jones C, Weal M, Barnett K: Developing and evaluating interventions to reduce inappropriate prescribing by general practitioners of antibiotics for upper respiratory tract infections: a randomised controlled trial to compare paper-based and web-based modelling experiments. Implement Sci 2011, 6:16. BioMed Central Full Text
• [36]Schünemann HJ, Hill S, Kakad M, Vist G, Bellamy R, Stockman L, Wisloff T, Del Mar C, Shindo N, Fukuda K, Hayden F, Uyeki T, Farrar Yazdanpanah Y, Zucker H, Beigel J, Chotpitayasunondh T, Hien TT, Ozbay B, Sugaya N, Oxman AD: Transparent Development of the WHO Rapid Advice Guidelines. PLoS Med 2007, 4:119.
• [37]Guyatt GH, Oxman AD, Akl EA, Kunz R, Vist G, Brozek J, Norris S, Falk-Ytter Y, Glasziou P, DeBeer H, Jaeschke R, Rind D, Meerpohl J, Dahm P, Schünemann HJ: GRADE guidelines 1. Introduction - GRADE evidence profiles and summary of findings tables. J Clin Epidemiol 2011, 64:383-394.
• [38]Guyatt GH, Norris SL, Schulman S, Hirsh J, Eckman MH, Akl EA, Crowther M, Vandvik PO, Eikelboom JW, McDonagh MS, Lewis SZ, Gutterman DD, Cook DJ, Schünemann HJ, American College of Chest Physicians: Methodology for the development of antithrombotic therapy and prevention of thrombosis guidelines: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012, 141(2):53S-70S.
• [39]Michie S, Lester K: Words matter: increasing the implementation of clinical guidelines. Qual Saf Health Care 2005, 14:367-370.
• [40]Michie S, Johnston M: Changing clinical behaviour by making guidelines specific. BMJ 2004, 328:343-345.