Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.
Columbia University School of Nursing/Herbert Irving Cancer Center, New York, New York, United States of America.
PLoS One. 2023 Feb 21;18(2):e0281890. doi: 10.1371/journal.pone.0281890. eCollection 2023.
To develop a summary format of clinical practice guideline (CPG) recommendations to improve understandability among health care professionals.
We developed a summary format based on current research and used the "Think Aloud" technique in one-on-one cognitive interviews to iteratively improve it. Interviews of health care professionals from Children's Oncology Group-member, National Cancer Institute Community Oncology Research Program sites were conducted. After every five interviews (a round), responses were reviewed, and changes made to the format until it was well understood and no new, substantive suggestions for revision were raised. We took a directed (deductive) approach to content analysis of the interview notes to identify concerns related to recommendation summary usability, understandability, validity, applicability and visual appeal.
During seven rounds of interviews with 33 health care professionals, we identified important factors that influenced understandability. Participants found understanding weak recommendations more challenging than strong recommendations. Understanding was improved when the term 'conditional' recommendation was used instead of 'weak' recommendation. Participants found a Rationale section to be very helpful but desired more information when a recommendation entailed a practice change. In the final format, the recommendation strength is clearly indicated in the title, highlighted, and defined within a text box. The rationale for the recommendation is in a column on the left, with supporting evidence on the right. In a bulleted list, the Rationale section describes the benefits and harms and additional factors, such as implementation, that were considered by the CPG developers. Each bullet under the supporting evidence section indicates the level of evidence with an explanation and the supporting studies with hyperlinks when applicable.
A summary format to present strong and conditional recommendations was created through an iterative interview process. The format is straightforward, making it easy for organizations and CPG developers to use it to communicate recommendations clearly to intended users.
制定临床实践指南（CPG）建议的摘要格式，以提高卫生保健专业人员的理解能力。
我们基于当前的研究制定了一种摘要格式，并使用“大声思考”技术进行一对一的认知访谈，以对其进行迭代改进。我们对来自儿童肿瘤学组-国家癌症研究所社区肿瘤学研究计划站点的卫生保健专业人员进行了访谈。在每进行五次访谈（一轮）后，都会审查回复内容，并对格式进行修改，直到它被很好地理解，并且没有提出新的、实质性的修订建议为止。我们采用有针对性（演绎）的方法对访谈记录进行内容分析，以确定与建议摘要可用性、可理解性、有效性、适用性和视觉吸引力相关的问题。
在与 33 名卫生保健专业人员进行的七轮访谈中，我们确定了影响可理解性的重要因素。参与者发现理解弱推荐比理解强推荐更具挑战性。当使用“有条件”推荐而不是“弱”推荐时，理解能力会得到提高。参与者发现“理由”部分非常有帮助，但当推荐涉及实践改变时，他们希望获得更多信息。在最终的格式中，推荐的强度在标题中明确表示，突出显示，并在文本框内定义。推荐的理由在左侧的列中，支持证据在右侧。在项目符号列表中，“理由”部分描述了益处和危害以及其他因素，例如实施情况，这些都是 CPG 开发人员考虑的因素。支持证据部分下的每个项目符号表示证据水平，并附有解释和适用时的支持研究的超链接。
通过迭代访谈过程创建了呈现强推荐和有条件推荐的摘要格式。该格式简单明了，便于组织和 CPG 开发人员使用它向预期用户清晰地传达建议。
