The University of Sydney's Northern Clinical School Intensive Care Research Unit, Sydney Medical School, University of Sydney, Australia.
The University of Sydney's Northern Clinical School Intensive Care Research Unit, Sydney Medical School, University of Sydney, Australia.
J Crit Care. 2020 Feb;55:9-15. doi: 10.1016/j.jcrc.2019.10.001. Epub 2019 Oct 19.
Evidence summary resources are popular with clinicians but it is unknown whether they can influence clinical decision making. We evaluated whether an extremely condensed and explicit evidence summary tool could influence clinical decision making.
An evidence summary tool was developed using a formal mapping exercise and graphic design principles. An invitation to participate was sent to subscribers of a critical care e-mail discussion list. Participants received a study package (evidence summary tool précising prone positioning in severe ARDS; case-based scenario describing a patient with severe ARDS plus evaluation questionnaire). Influence on clinical decisions was captured regarding six competing interventions, with Belief in benefit measured before and after reading the summary tool.
Among 93 participants, 87% were male with a mean age of 49.6(SD9.3) years. Mean ICU experience was 20.0(SD9.9) years. The evidence summary tool significantly influenced clinical decision making: belief in benefit of prone positioning increased (P < .001), belief in benefit of higher PEEP decreased (P = .002) and belief in benefit in ECMO decreased (P = .07).
Using a before-after evaluation, we demonstrated an extremely condensed and explicit information format can influence clinical decision making. Evidence summary tools may be a useful adjunct to support closing evidence-practice gaps.
证据摘要资源在临床医生中很受欢迎，但尚不清楚它们是否能影响临床决策。我们评估了一种极其简洁明了的证据摘要工具是否能影响临床决策。
使用正式的映射练习和图形设计原则开发了一种证据摘要工具。向重症监护电子讨论列表的订户发送了参与邀请。参与者收到了一份研究包（证据摘要工具，明确俯卧位治疗严重 ARDS；基于病例的描述严重 ARDS 患者的情景加上评估问卷）。针对六种竞争干预措施，在阅读摘要工具前后测量对临床决策的影响，以及对益处的信念。
在 93 名参与者中，87%为男性，平均年龄为 49.6（9.3）岁。平均 ICU 经验为 20.0（9.9）年。证据摘要工具显著影响临床决策：对俯卧位益处的信念增加（P <.001），对更高 PEEP 益处的信念降低（P =.002），对 ECMO 益处的信念降低（P =.07）。
我们通过前后评估表明，一种极其简洁明了的信息格式可以影响临床决策。证据摘要工具可能是支持缩小证据实践差距的有用辅助手段。
