Do Clinicians Want Recommendations?

Do Clinicians Want Recommendations? A Randomized Trial Comparing Evidence Summaries With and Without Evidence Based Recommendations

The use of the best evidence available for decision-making is nowadays an undisputed goal in health care. However, this is not always achieved in the context of clinical practice. Two of the potential solutions to bridge the gap between evidence and the clinical practice are the "evidence summaries" and the "evidence based recommendations". However, it is not clear, and frequently controversial, to what extent clinicians consider helpful recommendations accompanying evidence summaries. The investigators will explore this question by conducting a study where clinicians will be randomized to receive a clinical scenario accompanied by an evidence summary plus a recommendation and a second clinical scenario accompanied by only for an evidence summary (group A) or vice versa (Group B). The outcome will be clinicians' preferences.

Study Overview

• Status: Completed
• Conditions: Healthy Individuals (Clinicians)
• Intervention / Treatment: Other: Evidence summary alone plus a recommendation; Other: Evidence summary alone

• Study Type: Interventional
• Enrollment (Actual): 467
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Canada
  • Ontario
    • Hamilton, Ontario, Canada, L8S 4K1
      • McMaster University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Were trained as Medical Doctors
• Practice primary care or general internal medicine.

Exclusion Criteria: none

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Group A; We will present to participants two general clinical scenarios. The first scenario will be accompanied by an evidence summary plus a recommendation and a second scenario will be accompanied by an evidence summary alone	Other: Evidence summary alone plus a recommendation; Other: Evidence summary alone
Experimental: Group B; We will present to participants two general clinical scenarios. The first scenario will be accompanied by an evidence summary alone and a second scenario will be accompanied by an evidence summary plus a recommendation	Other: Evidence summary alone plus a recommendation; Other: Evidence summary alone

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Preferences	Preference: for the evidence summary plus the accompanying recommendation or for the evidence summary alone. We will assess this outcome with a 7-point Lickert scale This outcome will be assessed after the presentation of the two clinical scenarios.	Immediately after the intervention (Survey)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Understanding	Understanding: Percentage of correct answers regarding the understanding of the evidence: understanding of baseline risk, risk difference, confidence interval and quality of the evidence assessment.	Immediately after the intervention (Survey)
Interpretation of benefits and harms	Interpretation of benefits and harms: Distribution of the interpretation of the magnitude of the benefits in comparison with harms	Immediately after the intervention (Survey)
Intended course of action	Intended course of action: For the clinical questions related with strong recommendations, we will compare the percentage of appropriate decisions (i.e. decisions that match the strong recommendation).	Immediately after the intervention (Survey)

Collaborators and Investigators

• Sponsor: McMaster University
• Investigators: Principal Investigator: Holger Schunemann, MD, PhD, McMaster University

Publications and helpful links

General Publications

• Neumann I, Alonso-Coello P, Vandvik PO, Agoritsas T, Mas G, Akl EA, Brignardello-Petersen R, Emparanza J, McCullagh L, De Sitio C, McGinn T, Almodaimegh H, Almodaimegh K, Rivera S, Rojas L, Stirnemann J, Irani J, Hlais S, Mustafa R, Bdair F, Aly A, Kristiansen A, Izcovich A, Ramirez A, Brozek J, Guyatt G, Schunemann HJ. Do clinicians want recommendations? A multicenter study comparing evidence summaries with and without GRADE recommendations. J Clin Epidemiol. 2018 Jul;99:33-40. doi: 10.1016/j.jclinepi.2018.02.026. Epub 2018 Mar 9.

Study record dates

Study Major Dates

• Study Start: September 30, 2013
• Primary Completion (Actual): August 30, 2017
• Study Completion (Actual): August 30, 2017

Study Registration Dates

• First Submitted: November 19, 2013
• First Submitted That Met QC Criteria: December 4, 2013
• First Posted (Estimate): December 9, 2013

Study Record Updates

• Last Update Posted (Actual): September 1, 2017
• Last Update Submitted That Met QC Criteria: August 31, 2017
• Last Verified: August 1, 2017

More Information

Terms related to this study

• Other Study ID Numbers: 13-480