BackgroundClinical practice guidelines are typically written for healthcare providers but there is increasing interest in producing versions for the public, patients and carers. The main objective of this review is to identify and synthesise evidence of the public’s attitudes towards clinical practice guidelines and evidence-based recommendations written for providers or the public, together with their awareness of guidelines.MethodsWe included quantitative and qualitative studies of any design reporting on public, patient (and their carers) attitudes and awareness of guidelines written for providers or patients/public. We searched electronic databases including MEDLINE, PSYCHINFO, ERIC, ASSIA and the Cochrane Library from 2000 to 2012. We also searched relevant websites, reviewed citations and contacted experts in the field. At least two authors independently screened, abstracted data and assessed the quality of studies. We conducted a thematic analysis of first and second order themes and performed a separate narrative synthesis of patient and public awareness of guidelines.ResultsWe reviewed 5415 records and included 26 studies (10 qualitative studies, 13 cross sectional and 3 randomised controlled trials) involving 24 887 individuals. Studies were mostly good to fair quality. The thematic analysis resulted in four overarching themes: Applicability of guidelines; Purpose of guidelines for patient; Purpose of guidelines for health care system and physician; and Properties of guidelines. Overall, participants had mixed attitudes towards guidelines; some participants found them empowering but many saw them as a way of rationing care. Patients were also concerned that the information may not apply to their own health care situations. Awareness of guidelines ranged from 0-79%, with greater awareness in participants surveyed on national guideline websites.ConclusionThere are many factors, not only formatting, that may affect the uptake and use of guideline-derived material by the public. Producers need to make clear how the information is relevant to the reader and how it can be used to make healthcare improvements although there were problems with data quality. Awareness of guidelines is generally low and guideline producers cannot assume that the public has a more positive perception of their material than of alternative sources of health information.

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Background: Guideline producers are increasingly producing versions of guidelines for the public. The aim of this study was to explore what patients and the public understand about the purpose and production of clinical guidelines, and what they want from clinical guidelines to support their healthcare decisions.

The findings suggest that while recent salary increases may have helped to improve morale, other factors must also be addressed if further decline in morale and a subsequent nursing shortage is to be avoided.

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There is growing interest in the potential of artificial intelligence to support decision-making in health and social care settings. There is, however, currently limited evidence of the effectiveness of these systems. The aim of this study was to investigate the effectiveness of artificial intelligence-based computerised decision support systems in health and social care settings. We conducted a systematic literature review to identify relevant randomised controlled trials conducted between 2013 and 2018. We searched the following databases: MEDLINE, EMBASE, CINAHL, PsycINFO, Web of Science, Cochrane Library, ASSIA, Emerald, Health Business Fulltext Elite, ProQuest Public Health, Social Care Online, and grey literature sources. Search terms were conceptualised into three groups: artificial intelligence-related terms, computerised decision support -related terms, and terms relating to health and social care. Terms within groups were combined using the Boolean operator OR, and groups were combined using the Boolean operator AND. Two reviewers independently screened studies against the eligibility criteria and two independent reviewers extracted data on eligible studies onto a customised sheet. We assessed the quality of studies through the Critical Appraisal Skills Programme checklist for randomised controlled trials. We then conducted a narrative synthesis. We identified 68 hits of which five studies satisfied the inclusion criteria. These studies varied substantially in relation to quality, settings, outcomes, and technologies. None of the studies was conducted in social care settings, and three randomised controlled trials showed no difference in patient outcomes. Of these, one investigated the use of Bayesian triage algorithms on forced expiratory volume in 1 second (FEV1) and health-related quality of life in lung transplant patients. Another investigated the effect of image pattern recognition on neonatal development outcomes in pregnant women, and another investigated the effect of the Kalman filter technique for warfarin dosing suggestions on time in therapeutic range. The remaining two randomised controlled trials, investigating computer vision and neural networks on medication adherence and the impact of learning algorithms on assessment time of patients with gestational diabetes, showed statistically significant and clinically important differences to the control groups receiving standard care. However, these studies tended to be of low quality lacking detailed descriptions of methods and only one study used a double-blind design. Although the evidence of effectiveness of data-driven artificial intelligence to support decision-making in health and social care settings is limited, this work provides important insights on how a meaningful evidence base in this emerging field needs to be developed going forward. It is unlikely that any single overall message surrounding effectiveness will emerge - rather effectiveness of interventions is likely to be context-specific and calls for inclusion of a range of study designs to investigate mechanisms of action.

ContextThe Scottish Government has identified computerised decision support as a strategic priority in order to improve knowledge management in health and social care settings. A national programme to build a pilot Decision Support Platform was funded in 2015.AimsWe undertook a formative evaluation of the Decision Support Platform to inform plans for its national roll-out in primary care.MethodsWe conducted a series of in-depth semistructured interviews and non-participant observations of workshops demonstrating decision support systems. Participants were policymakers and clinical opinion leaders from primary care. As the Platform was in its early stages of development at the time of data collection, we focused on exploring expectations and drivers of the pilot decision support system tested in primary care. Our methodological approach had to be tailored to changing circumstances and offered important opportunities for realising impact through ongoing formative feedback to policymakers and active engagement of key clinical stakeholders. We drew on sociotechnical principles to inform data analysis and coded qualitative data with the help of NVivo software.FindingsWe conducted 30 interviews and non-participant ethnographic observations of eight stakeholder engagement workshops. We observed a strong sense of support from all stakeholders for the Platform and associated plans to roll it out across NHS Scotland. Strategic drivers included the potential to facilitate integration of care, preventive care, patient self-management, shared decision-making and patient engagement through the ready availability of clinically important information. However, in order to realise these benefits, participants highlighted the need for strong national eHealth leadership to drive a coherent strategy and ensure sustained funding, system usability (which stakeholders perceived to be negatively affected by alert fatigue and integration with existing systems) and ongoing monitoring of potential unintended consequences emerging from implementations (eg, increasing clinical workloads).Conclusions and implicationsIn order to address potential tensions between national leadership and local usability as well as unintended consequences, there is a need to have overall national ownership to support the implementation of the Platform. Potential local tensions could be addressed through allowing a degree of local customisation of systems and tailoring of alerts, and investing in a limited number of pilots that are carefully evaluated to mitigate emerging risks early.

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