Do clinicians want recommendations? A multi-center study comparing evidence summaries with and without GRADE recommendations

Neumann I, Alonso-Coello P, Vandvik PO, Agoritsas T, Mas G, Akl EA, et al.

Journal of Clinical Epidemiology , Article in press.

Abstract

Background

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 pre-appraised evidence summaries alone, rather than recommendations, is more appropriate.

Objectives

To evaluate clinicians’ preferences, understanding of the evidence and intended course of action in response to evidence summaries with and without recommendations.

Methods

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

189/219 (86%) and 201/248 (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). Presence of a recommendation resulted in a more appropriate intended course of action for two scenarios involving strong recommendations.

Discussion

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).

USPSTF Perspective on Evidence-Based Preventive Recommendations for Children

Published online July 2, 2012 Pediatrics Vol. 130 No. 2 August 1, 2012
pp. e399 -e407
(doi: 10.1542/peds.2011-2087)

The development and use of evidence-based recommendations for preventive care by primary care providers caring for children is an ongoing challenge.
This issue is further complicated by the fact that a higher proportion of recommendations by the US Preventive Services Task Force (USPSTF) for pediatric preventive services in comparison with adult services have insufficient evidence to recommend for or against the service. One important root cause for this problem is the relative lack of high quality screening and counseling studies in pediatric primary care settings. The paucity of studies limits the development of additional evidence-based guidelines to enhance best practices for pediatric and adolescent conditions. In this article, we describe the following: (1) evidence-based primary care preventive services as a strategy for addressing important pediatric morbidities, (2) the process of making evidence-based screening recommendations by the USPSTF, (3) the current library of USPSTF recommendations for children and adolescents, and (4) factors influencing the use of USPSTF recommendations and other evidence-based guidelines by clinicians. Strategies to accelerate the implementation of evidence-based services and areas of need for future research to fill key gaps in evidence-based recommendations and guidelines are highlighted.