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Determinants of complexity in clinical practice guidelines: a Delphi study including perspectives from guideline
Marleen Corremans1,2, Zachary Munn3, Sanne Peters4
1JBI Belgium Centre for Supporting Evidence-Based Health Care, Leuven, Belgium.
JBI Evidence Implementation
|March 10, 2025
Summary
This study identifies ten key factors influencing the complexity of developing and implementing evidence-based clinical practice guidelines. Understanding these determinants is crucial for effective guideline adoption in healthcare.
Area of Science:
- Health Services Research
- Clinical Practice Guidelines
- Intervention Science
Background:
- The Medical Research Council (MRC) framework guides the development and implementation of complex interventions.
- Evidence-based clinical practice guidelines (CPGs) provide recommendations for adopting interventions.
- Factors influencing the complexity of CPGs require detailed examination.
Purpose of the Study:
- To describe the determinants of complexity in the development and implementation of evidence-based clinical practice guidelines.
- To assess the applicability of MRC's complex intervention elements to CPGs.
Main Methods:
- A working group of 16 participants was formed, including a debate team and a Delphi panel.
- The debate team defined key elements of MRC's complex intervention definition for guideline applicability.
- The Delphi panel assessed the relevance of these elements to CPG complexity.
Main Results:
- Consensus was reached on ten elements defining aspects of guideline complexity after two Delphi rounds.
- Inter-rater reliability ranged from 0.83 to 1.00 for the identified elements.
- No agreement was reached on excluding any specific element.
Conclusions:
- Increased number of components, settings, behaviors, and stakeholders contribute to guideline complexity.
- Gaps between guidelines and clinical reality, educational differences, collaboration levels, scope of change, evidence level, and workload also determine complexity.
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