Do clinicians want recommendations? A multicenter study comparing evidence summaries with and without GRADE...

Area of Science:

• Clinical Practice Guidelines
• Evidence-Based Medicine
• Health Sciences Education

Background:

• Clinical practice guidelines aim to bridge the gap between research evidence and practice.
• Debate exists on whether to provide preappraised evidence summaries or explicit recommendations.
• Understanding clinician preferences for evidence presentation is crucial for effective knowledge translation.

Purpose of the Study:

• To evaluate clinicians' preferences for evidence summaries with or without recommendations.
• To assess clinicians' understanding of evidence summaries and their intended course of action.
• To determine the impact of recommendations on clinical decision-making in low-certainty evidence scenarios.

Main Methods:

• Practicing clinicians from 10 countries participated in educational sessions.
• Participants received clinical scenarios with low/very low certainty evidence, with or without GRADE recommendations.
• Randomization determined the format: evidence summary alone vs. summary with recommendation.

Main Results:

• A significant majority (81-86%) preferred evidence summaries accompanied by recommendations.
• Less than half of clinicians accurately interpreted evidence summaries, including effect estimates and certainty.
• Recommendations improved the intended course of action in scenarios with strong recommendations.

Conclusions:

• Evidence summaries alone are insufficient to influence clinicians' actions.
• Clinicians strongly prefer recommendations alongside evidence summaries, particularly when evidence certainty is low.
• Integrating recommendations enhances the utility of evidence summaries for clinical practice.