Department of Internal Medicine, Pontificia Universidad Catolica de Chile, Alameda 340, Santiago 8331150, Chile.
Centro Cochrane Iberoamericano, Instituto de Investigación Biomédica (CIBERESP-IIB Sant Pau), C/ Sant Antoni Maria Claret 167, Barcelona 08025, Spain.
J Clin Epidemiol. 2018 Jul;99:33-40. doi: 10.1016/j.jclinepi.2018.02.026. Epub 2018 Mar 9.
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.
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.
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.
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).
循证临床实践指南提供建议，以协助临床医生做出决策，并缩小当前最佳研究证据与临床实践之间的差距。然而，有人认为，提供预先评估的证据摘要而不是建议更为合适。本研究旨在评估临床医生对证据摘要（有或无建议）的偏好、对证据的理解以及对预期行动的理解。
我们纳入了在 10 个国家参加教育课程的执业临床医生。临床医生被随机分配，根据低或极低确定性的研究证据，接受相关临床情况，并伴有 GRADE 系统制定的强或弱推荐。在每组内，参与者进一步随机分配接受推荐加相应的证据摘要或仅证据摘要。我们评估了参与者对呈现策略的偏好和理解，以及他们的预期行动。
189 名参与者（86%）和 201 名参与者（81%）分别对强烈推荐和弱推荐的证据摘要都更倾向于有推荐。在所有情况下，不到一半的参与者正确解读了证据摘要中提供的信息（例如，效果估计、研究证据的确定性）。在涉及强烈推荐的两个情况下，建议的存在导致了更适当的预期行动。
仅提供证据摘要不足以影响临床医生的行动。临床医生显然更喜欢在证据确定性低或极低的情况下，有推荐伴随证据摘要（试验注册号 NCT02006017）。
