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Title: Do clinicians want recommendations? A multicenter study comparing evidence summaries with and without GRADE recommendations
Authors: Neumann, Ignacio
Alonso-Coello, Pablo
Vandvik, Per Olav
Agoritsas, Thomas
Mas, Gemma
Akl, Elie A.
Brignardello-Petersen, Romina
Emparanza, Jose
McCullagh, Lauren
De Sitio, Catherine
McGinn, Thomas
Almodaimegh, Hind
Almodaimegh, Khalid
Rivera, Solange
Rojas, Luis
Stirnemann, Jérôme
Irani, Jihad
Hlais, Sani
Mustafa, Reem
Bdair, Fadi
Aly, Abdelrahman
Kristiansen, Annette
Izcovich, Ariel
Ramirez, Anggie
Brozek, Jan
Guyatt, Gordon
Schünemann, Holger J.
Affiliations: Faculty of Medicine 
Keywords: Clinical practice guidelines
Clinicians’ preferences
Evidence synthesis
Evidence-based medicine
Knowledge translation
Issue Date: 2018
Publisher: Elsevier
Part of: Journal of Clinical Epidemiology
Volume: 99
Start page: 33
End page: 40
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).
ISSN: 08954356
DOI: 10.1016/j.jclinepi.2018.02.026
Ezproxy URL: Link to full text
Type: Journal Article
Appears in Collections:Faculty of Medicine

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