Comparison of Alternative Evidence Summary and Presentation Formats in Clinical Guideline Development: A Mixed-Method Study

Abstract

BackgroundBest formats for summarising and presenting evidence for use in clinical guideline development remain less well defined. We aimed to assess the effectiveness of different evidence summary formats to address this gap.MethodsHealthcare professionals attending a one-week Kenyan, national guideline development workshop were randomly allocated to receive evidence packaged in three different formats: systematic reviews (SRs) alone, systematic reviews with summary-of-findings tables, and ‘graded-entry’ formats (a ‘front-end’ summary and a contextually framed narrative report plus the SR). The influence of format on the proportion of correct responses to key clinical questions, the primary outcome, was assessed using a written test. The secondary outcome was a composite endpoint, measured on a 5-point scale, of the clarity of presentation and ease of locating the quality of evidence for critical neonatal outcomes. Interviews conducted within two months following completion of trial data collection explored panel members’ views on the evidence summary formats and experiences with appraisal and use of research information.Results65 (93%) of 70 participants completed questions on the prespecified outcome measures. There were no differences between groups in the odds of correct responses to key clinical questions. ‘Graded-entry’ formats were associated with a higher mean composite score for clarity and accessibility of information about the quality of evidence for critical neonatal outcomes compared to systematic reviews alone (adjusted mean difference 0.52, 95% CI 0.06 to 0.99). There was no difference in the mean composite score between SR with SoF tables and SR alone. Findings from interviews with 16 panelists indicated that short narrative evidence reports were preferred for the improved clarity of information presentation and ease of use.ConclusionsOur findings suggest that ‘graded-entry’ evidence summary formats may improve clarity and accessibility of research evidence in clinical guideline development.Trial RegistrationControlled-Trials.com ISRCTN05154264

A Guide for Developing Plain-Language and Contextual Summaries of Systematic Reviews in Agri-Food Public Health

“…The authors found that the threepage summary format with supporting contextual information was the most preferred source of systematic review knowledge to inform policy-making (49% of respondents) as compared to the one-page summaries (23%), the full journal article (15%), and a quantitative ''summary-of-findings'' table format (13%) (Pham et al, 2013). These results correspond to similar findings in the health sector, indicating that end-users prefer to receive systematic review knowledge in a contextualized plain-language format (Lavis et al, 2005;Rosenbaum et al, 2011;Opiyo et al, 2013). Additional research is necessary to evaluate the utility of these summary formats further among different populations of end-users in this sector.…”

“…We developed the guideline and summary formats based on a review and evaluation of existing plain-language and contextual summaries in health and other sectors (Canadian Foundation for Healthcare Improvement, 2010; Rosenbaum et al, 2011;Khangura et al, 2012;Health Evidence, 2013;Opiyo et al, 2013;ResearchImpact, 2014). The one-and three-page formats were prioritized based on consultation with end-users who indicated preference for graded-entry summaries (i.e., multiple layers of short and longer summaries) and the addition of contextual information to highlight the relevance of the systematic review findings for decision-making (Rosenbaum et al, 2011;Khangura et al, 2012;Opiyo et al, 2013). The target end-users for the summaries includes professionals working at the science-to-policy interface in the agri-food public health sector, which we define as policy-makers and those who support them (e.g., policy and research analysts), practitioners, extension personnel, program officers and specialists, and other government and industry decision-makers .…”

“…Another criticism of systematic reviews that investigate questions of intervention efficacy is that they typically do not address contextual factors relevant to the review question, such as implementation costs, local applicability and availability, and other important stakeholder considerations (Lavis et al, 2005;Lavis, 2009;. As a result, various groups in the health sector have developed systematic review summary documents that are ideal for rapid scanning, presented in an appealing format, written in plain language, have clearly formulated ''take-home'' messages, and in some cases, also incorporate supporting contextual information (Lavis, 2009;Rosenbaum et al, 2011;Khangura et al, 2012;Opiyo et al, 2013;Health Evidence, 2013;.…”

What are the best methodologies for rapid reviews of the research evidence for evidence-informed decision making in health policy and practice: a rapid review

“…Five systematic reviews (from seven articles) [18, 19, 21, 30–33] and one primary study with a strong study design – a RCT [34] – met the inclusion criteria for the review. The selection process for studies and the numbers at each stage are shown in Fig.…”

Series: Clinical Epidemiology in South Africa. Paper 1: Evidence-based health care and policy in Africa: past, present, and future

“…There have also been promising developments in clinical guideline development and evaluation in the African region [13,19,20]. For example, Kredo and co-authors [19], assessed 30 regional guidelines from 13 countries linked to five priority diseases and found quality gaps in relation to the AGREE II tool and variable concordance with current best evidence.…”