Including practice data to improve evidence-based guidelines. Example of guidelines on the management of thyroid...

Although clinical guidelines are based on the best evidence available, their proliferation has often failed to change actual practice. One of the many explanations suggested is that there is a gap between the expectations of the targeted professionals and the recommendations in the guidelines. In this study, we attempted to take into account the state of current practice and the physicians' priorities. Using the example of guidelines on the management of thyroid nodules, three different surveys have been conducted: (1) an analysis of physicians' expectations and practice through a postal questionnaire to define appropriate questions; (2) a survey of the professionals' expert opinions, and (3) a prospective study of the use of these guidelines in the management of 253 patients. The results of these surveys have modified the development of the guidelines, and helped us to adapt the content of the guidelines to match physicians' practices more closely.