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Original Research: Education, Research, and Quality Improvement |

Development of a Novel, Multilayered Presentation Format for Clinical Practice GuidelinesPresentation Format for Clinical Guidelines

Annette Kristiansen, MD; Linn Brandt, MD; Pablo Alonso-Coello, MD, PhD; Thomas Agoritsas, MD; Elie A. Akl, MD, PhD, MPH; Tara Conboy, RGN, MSc; Mahmoud Elbarbary, MD, PhD; Mazen Ferwana, MD, PhD; Wedad Medani, MSc; Mohammad Hassan Murad, MD, MPH; David Rigau, MD; Sarah Rosenbaum, PhD; Frederick A. Spencer, MD; Shaun Treweek, PhD; Gordon Guyatt, MD, FCCP; Per Olav Vandvik, MD, PhD
Author and Funding Information

From the Department of Internal Medicine (Drs Kristiansen, Brandt, and Vandvik), Innlandet Hospital Trust, Gjøvik, Norway; Institute for Health and Society (Drs Kristiansen, Brandt, and Vandvik), Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Internal Medicine (Drs Kristiansen and Brandt), Diakonhjemmet Hospital, Oslo, Norway; Iberoamerican Cochrane Centre, Clinical Epidemiology and Public Health Department (Drs Alonso-Coello and Rigau), Institute of Biomedical Research, Sant Pau, Spain; Department of Clinical Epidemiology and Biostatistics (Drs Agoritsas and Guyatt) and Department of Medicine (Dr Spencer), McMaster University, Hamilton, ON, Canada; Department of Internal Medicine (Dr Akl), American University of Beirut, Beirut, Lebanon; National & Gulf Center for Evidence Based Health Practice (Mss Conboy and Medani and Drs Elbarbary and Ferwana), King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; Mayo Clinic (Dr Murad), Rochester, MN; The Norwegian Knowledge Centre for the Health Services (Drs Rosenbaum and Vandvik), Oslo, Norway; and Health Services Research Unit (Prof Treweek), University of Aberdeen, Aberdeen, Scotland.

CORRESPONDENCE TO: Pablo Alonso-Coello, MD, PhD, Iberoamerican Cochrane Centre, Clinical Epidemiology and Public Health Department, Institute of Biomedical Research, Sant Pau, Spain 08025; e-mail: PAlonso@santpau.cat


Portions of this study have been presented in a poster at the 9th Guideline International Network Conference, August 22-25, 2012, Berlin, Germany; the 10th Guideline International Network Conference, August 18-21, 2013, San Francisco, CA; and at the 11th Guideline International Network Conference, August 20-23, 2014, Melbourne, Australia.

FUNDING/SUPPORT: This project has received funding from the European Union’s Seventh Framework Programme for research, technological development, and demonstration under grant agreement no. 258583. The Innlandet Hospital Trust and South-Eastern Norway Regional Health Authority have provided research grants for the MAGIC program.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;147(3):754-763. doi:10.1378/chest.14-1366
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BACKGROUND:  Bridging the gap between clinical research and everyday health-care practice requires effective communication strategies. To address current shortcomings in conveying practice recommendations and supporting evidence, we are creating and testing presentation formats for clinical practice guidelines (CPGs).

METHODS:  We carried out multiple cycles of brainstorming and sketching, developing a prototype. Physicians participating in the user testing viewed CPG formats linked to clinical scenarios and engaged in semistructured interviews applying a think-aloud method for exploring important aspects of user experience.

RESULTS:  We developed a multilayered presentation format that allows clinicians to successively view more in-depth information. Starting with the recommendations, clinicians can, on demand, access a rationale and a key information section containing statements on quality of the evidence, balance between desirable and undesirable consequences, values and preferences, and resource considerations. We collected feedback from 27 stakeholders and performed user testing with 47 practicing physicians from six countries. Advisory group feedback and user testing of the first version revealed problems with conceptual understanding of underlying CPG methodology, as well as difficulties with the complexity of the layout and content. Extensive revisions made before the second round of user testing resulted in most participants expressing overall satisfaction with the final presentation format.

CONCLUSIONS:  We have developed an electronic, multilayered, CPG format that enhances the usability of CPGs for frontline clinicians. We have implemented the format in electronic guideline tools that guideline organizations can now use when authoring and publishing their guidelines.

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Multilayered Format

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