McDonald Steve, Elliott Julian H, Green Sally, Turner Tari
Cochrane Australia, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia.
F1000Res. 2019 Jun 24;8:956. doi: 10.12688/f1000research.19661.1. eCollection 2019.
Many organisations in Australia undertake systematic reviews to inform development of evidence-based guidelines or would like to do so. However, the substantial resources required to produce systematic reviews limit the feasibility of evidence-based approaches to guideline development. We are working with Australian guideline developers to design, build and test systems that make creating evidence-based guidelines easier and more efficient. To understand the evidence needs of guideline developers and to inform the development of potential tools and services, we conducted 16 semi-structured interviews with Australian guideline developers. Developers were involved in different types of guidelines, represented both new and established guideline groups, and had access to widely different levels of resources. All guideline developers recognised the importance of having access to timely evidence to support their processes, but were frequently overwhelmed by the scale of this task. Groups developing new guidelines often underestimated the time, expertise and work involved in completing searching and screening. Many were grappling with the challenge of updating and were keen to explore alternatives to the blanket updating of the full guideline. Horizon-scanning and evidence signalling were seen as providing more pragmatic approaches to updating, although some were wary of challenges posed by receiving evidence on a too-frequent basis. Respondents were aware that new technologies, such as machine learning, offered potentially large time and resource savings. As well as the constant challenge of managing financial constraints, Australian guideline developers seeking to develop clinical guidelines face several critical challenges. These include acquiring appropriate methodological expertise, investing in information technology, coping with the proliferation of research output, feasible publication and dissemination options, and keeping guidance up to date.
澳大利亚的许多组织开展系统评价，以为循证指南的制定提供信息，或者希望这样做。然而，开展系统评价所需的大量资源限制了循证方法在指南制定中的可行性。我们正与澳大利亚的指南制定者合作，设计、构建和测试系统，以使创建循证指南变得更轻松、更高效。为了解指南制定者的证据需求，并为潜在工具和服务的开发提供信息，我们对澳大利亚的指南制定者进行了16次半结构化访谈。这些制定者参与了不同类型的指南工作，代表了新成立和已成熟的指南小组，且可获取的资源水平差异很大。所有指南制定者都认识到获取及时证据以支持其工作流程的重要性，但常常被这项任务的规模压得喘不过气来。制定新指南的小组往往低估了完成检索和筛选所需的时间、专业知识和工作量。许多人正在应对更新方面的挑战，并渴望探索全面更新整个指南之外的替代方法。前瞻性扫描和证据信号被视为提供了更务实的更新方法，尽管有些人对过于频繁地接收证据所带来的挑战心存疑虑。受访者意识到，机器学习等新技术可能会大幅节省时间和资源。除了应对资金限制这一持续挑战外，寻求制定临床指南的澳大利亚指南制定者还面临若干关键挑战。这些挑战包括获取适当的方法学专业知识、投资信息技术、应对研究成果的激增、可行的发表和传播选项，以及使指南与时俱进。
