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Multicenter Study
. 2018 Jul:99:33-40.
doi: 10.1016/j.jclinepi.2018.02.026. Epub 2018 Mar 9.

Do clinicians want recommendations? A multicenter study comparing evidence summaries with and without GRADE recommendations

Ignacio Neumann  1 , Pablo Alonso-Coello  2 , Per Olav Vandvik  3 , Thomas Agoritsas  4 , Gemma Mas  2 , Elie A Akl  5 , Romina Brignardello-Petersen  6 , Jose Emparanza  7 , Lauren McCullagh  8 , Catherine De Sitio  8 , Thomas McGinn  9 , Hind Almodaimegh  10 , Khalid Almodaimegh  11 , Solange Rivera  12 , Luis Rojas  13 , Jérôme Stirnemann  14 , Jihad Irani  15 , Sani Hlais  16 , Reem Mustafa  17 , Fadi Bdair  18 , Abdelrahman Aly  17 , Annette Kristiansen  19 , Ariel Izcovich  20 , Anggie Ramirez  21 , Jan Brozek  22 , Gordon Guyatt  22 , Holger J Schünemann  22
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Multicenter Study

Do clinicians want recommendations? A multicenter study comparing evidence summaries with and without GRADE recommendations

Ignacio Neumann et al. J Clin Epidemiol. 2018 Jul.

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).

Keywords: Clinical practice guidelines; Clinicians' preferences; Evidence synthesis; Evidence-based medicine; GRADE; Knowledge translation.

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