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Randomized Controlled Trial
. 2017 Feb 10;7(2):e011569.
doi: 10.1136/bmjopen-2016-011569.

Multilayered and digitally structured presentation formats of trustworthy recommendations: a combined survey and randomised trial

Linn Brandt  1   2 , Per Olav Vandvik  1   2 , Pablo Alonso-Coello  3   4 , Elie A Akl  4   5 , Judith Thornton  6 , David Rigau  3 , Katie Adams  6 , Paul O'Connor  6 , Gordon Guyatt  4 , Annette Kristiansen  1   2
Affiliations
Randomized Controlled Trial

Multilayered and digitally structured presentation formats of trustworthy recommendations: a combined survey and randomised trial

Linn Brandt et al. BMJ Open. .

Abstract

Objectives: To investigate practicing physicians' preferences, perceived usefulness and understanding of a new multilayered guideline presentation format-compared to a standard format-as well as conceptual understanding of trustworthy guideline concepts.

Design: Participants attended a standardised lecture in which they were presented with a clinical scenario and randomised to view a guideline recommendation in a multilayered format or standard format after which they answered multiple-choice questions using clickers. Both groups were also presented and asked about guideline concepts.

Setting: Mandatory educational lectures in 7 non-academic and academic hospitals, and 2 settings involving primary care in Lebanon, Norway, Spain and the UK.

Participants: 181 practicing physicians in internal medicine (156) and general practice (25).

Interventions: A new digitally structured, multilayered guideline presentation format and a standard narrative presentation format currently in widespread use.

Primary and secondary outcome measures: Our primary outcome was preference for presentation format. Understanding, perceived usefulness and perception of absolute effects were secondary outcomes.

Results: 72% (95% CI 65 to 79) of participants preferred the multilayered format and 16% (95% CI 10 to 22) preferred the standard format. A majority agreed that recommendations (multilayered 86% vs standard 91%, p value=0.31) and evidence summaries (79% vs 77%, p value=0.76) were useful in the context of the clinical scenario. 72% of participants randomised to the multilayered format vs 58% for standard formats reported correct understanding of the recommendations (p value=0.06). Most participants elected an appropriate clinical action after viewing the recommendations (98% vs 92%, p value=0.10). 82% of the participants considered absolute effect estimates in evidence summaries helpful or crucial.

Conclusions: Clinicians clearly preferred a novel multilayered presentation format to the standard format. Whether the preferred format improves decision-making and has an impact on patient important outcomes merits further investigation.

Keywords: EPIDEMIOLOGY.

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Conflict of interest statement

All authors have completed the ICMJE uniform disclosure form. LB, AK, GG and POV are members of a non-profit research and innovation project MAGIC: http://www.magicproject.org, which has an open technical platform where the new DECIDE multilayered formats were prototyped. All authors were either co-investigators or collaborators of the DECIDE project. LB, AK, GG, POV, PA-C, EA, JT and DR are members of the Grade Working group. The strategy evaluated in the study is based on the GRADE approach. No other competing interests were declared.

Figures

Figure 1
Figure 1
(A and B) Current version of the multilayered guideline presentation formats. Thromboprophylaxis.
Figure 2
Figure 2
Standard and multilayered guideline presentation formats. NOAC, novel oral anticoagulant.
Figure 3
Figure 3
Flow chart of design and enrolment of participants to the multilayered format (n=92) and standard format (n=85).
Figure 4
Figure 4
Preferences for standard format versus multilayered presentation format.
Figure 5
Figure 5
Reported answers to the statement: ‘I fully understand the difference between strong and weak recommendations and the implications for clinical decision-making’.
See this image and copyright information in PMC

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