Shaughnessy Allen F, Vaswani Akansha, Andrews Bonnie K, Erlich Deborah R, D'Amico Frank, Lexchin Joel, Cosgrove Lisa
Tufts University School of Medicine, Boston, Massachusetts
Department of Counseling and School Psychology, University of Massachusetts, Boston, Massachusetts.
Ann Fam Med. 2017 Sep;15(5):413-418. doi: 10.1370/afm.2119.
Clinicians are faced with a plethora of guidelines. To rate guidelines, they can select from a number of evaluation tools, most of which are long and difficult to apply. The goal of this project was to develop a simple, easy-to-use checklist for clinicians to use to identify trustworthy, relevant, and useful practice guidelines, the Guideline Trustworthiness, Relevance, and Utility Scoring Tool (G-TRUST).
A modified Delphi process was used to obtain consensus of experts and guideline developers regarding a checklist of items and their relative impact on guideline quality. We conducted 4 rounds of sampling to refine wording, add and subtract items, and develop a scoring system. Multiple attribute utility analysis was used to develop a weighted utility score for each item to determine scoring.
Twenty-two experts in evidence-based medicine, 17 developers of high-quality guidelines, and 1 consumer representative participated. In rounds 1 and 2, items were rewritten or dropped, and 2 items were added. In round 3, weighted scores were calculated from rankings and relative weights assigned by the expert panel. In the last round, more than 75% of experts indicated 3 of the 8 checklist items to be major indicators of guideline usefulness and, using the AGREE tool as a reference standard, a scoring system was developed to identify guidelines as useful, may not be useful, and not useful.
The 8-item G-TRUST is potentially helpful as a tool for clinicians to identify useful guidelines. Further research will focus on its reliability when used by clinicians.
临床医生面临大量指南。为了对指南进行评级，他们可以从多种评估工具中进行选择，其中大多数工具冗长且难以应用。本项目的目标是开发一种简单易用的清单，供临床医生用于识别值得信赖、相关且有用的实践指南，即指南可信度、相关性和实用性评分工具（G-TRUST）。
采用改良的德尔菲法，就一系列项目及其对指南质量的相对影响，征求专家和指南制定者的共识。我们进行了四轮抽样，以完善措辞、增减项目并制定评分系统。使用多属性效用分析为每个项目制定加权效用得分，以确定评分。
22名循证医学专家、17名高质量指南制定者和1名消费者代表参与其中。在第一轮和第二轮中，对项目进行了改写或删除，并增加了2个项目。在第三轮中，根据专家小组给出的排名和相对权重计算加权得分。在最后一轮中，超过75%的专家指出8项清单项目中的3项是指南实用性的主要指标，并以AGREE工具作为参考标准，开发了一种评分系统，以确定指南是有用的、可能无用的还是无用的。
8项的G-TRUST作为临床医生识别有用指南的工具可能会有所帮助。进一步的研究将聚焦于临床医生使用该工具时的可靠性。
