Weberschock Tobias, Dreher Andreas, Follmann Markus, Nothacker Monika, Kopp Ina, Rosumek Stefanie, Nast Alexander
Arbeitsgruppe Evidenzbasierte Medizin, Institut für Allgemeinmedizin, Goethe-Universität Frankfurt, Frankfurt, Germany; Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Frankfurt, Frankfurt, Germany.
Arbeitsgruppe Evidenzbasierte Medizin, Institut für Allgemeinmedizin, Goethe-Universität Frankfurt, Frankfurt, Germany.
Z Evid Fortbild Qual Gesundhwes. 2016;113:1-8. doi: 10.1016/j.zefq.2016.05.010. Epub 2016 Jun 21.
Specific recommendations form the centerpiece of medical guidelines. The intended strength of a recommendation is usually expressed by the use of different wordings. Recent investigations showed that guideline users (recipients) interpret the binding character of wordings in different ways. The perception of different wording and their binding character of the strength of guideline recommendations among guideline developers (sender) have so far not been investigated in the German-speaking area.
German-speaking guideline developers were invited online and at specialist meetings to participate in a survey investigating 13 different terms used in guideline recommendations. The aim was to measure their perceived binding character on a visual analog scale (VAS: 0-100). Additional demographic and occupational data were collected. The results were compared with data from a previous survey among guideline users.
Overall, 136 guideline developers with an average of 4.2 (median 3) guideline (co-) authorships participated in the survey. While guideline developers interpreted the two imperative recommendations "must" and "must not" with a similarly high level of obligation, the level of obligation was not rated homogenously for strong and weak recommendations like "shall" or "should". Two out of five negative formulations were perceived as more binding than their corresponding positive formulations. In comparisons with the ratings of the guideline users the terms "darf nicht" (must not), (-5.8 VAS, p≤0.0001) and "muss" (must), (-2.9 VAS, p≤0.0006) were perceived as less binding by the guideline developers, as was "sollte nicht"(should not) (-6.6 VAS, p≤0.0001) and "kann nicht empfohlen werden" (cannot be recommended) (-9.4 VAS, p≤0.0001). Only "soll" (shall) was perceived as more binding (+8.7 VAS, p≤0.0001).
The current survey demonstrates that guideline developers perceive the binding character of terms used in guideline recommendations in a similar way as it was found for guideline users in a previous survey. Negative recommendations are more often rated as more binding by guideline developers as the corresponding positive terms. The discordant ratings by the guideline developers can be explained by their methodological knowledge regarding formulations of recommendations. It would be desirable that efforts be made to identify wordings in guidelines which better discriminate the intended level of obligation of guideline recommendations with regard to these results.
具体建议是医学指南的核心内容。建议的预期强度通常通过使用不同的措辞来表达。最近的调查表明，指南使用者（接受者）对措辞的约束性有不同的理解方式。到目前为止，在德语区尚未对指南制定者（发送者）对不同措辞及其对指南建议强度的约束性的认知进行调查。
通过在线方式以及在专业会议上邀请德语区的指南制定者参与一项调查，该调查涉及指南建议中使用的13个不同术语。目的是在视觉模拟量表（VAS：0 - 100）上衡量他们所感知的约束性。还收集了额外的人口统计学和职业数据。将结果与之前对指南使用者的一项调查数据进行比较。
总体而言，136名指南制定者参与了调查，他们平均有4.2项（中位数为3项）指南（共同）作者身份。虽然指南制定者对两个强制性建议“必须”和“不得”的义务程度理解相似，但对于“应”或“应当”等强弱不同的建议，义务程度的评级并不一致。五个否定表述中有两个被认为比相应的肯定表述更具约束力。与指南使用者的评级相比，“darf nicht”（不得）（-5.8 VAS，p≤0.0001）、“muss”（必须）（-2.9 VAS，p≤0.0006）被指南制定者认为约束力较小，“sollte nicht”（不应当）（-6.6 VAS，p≤0.0001）和“kann nicht empfohlen werden”（不能被推荐）（-9.4 VAS，p≤0.0001）也是如此。只有“soll”（应）被认为更具约束力（+8.7 VAS，p≤0.0001）。
当前的调查表明，指南制定者对指南建议中使用的术语的约束性的认知与之前对指南使用者的调查结果类似。指南制定者更常认为否定建议比相应的肯定表述更具约束力。指南制定者评级不一致的情况可以用他们关于建议措辞的方法学知识来解释。鉴于这些结果，希望努力在指南中确定能更好区分指南建议预期义务程度的措辞。
