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Table 1 Studies describing guideline features that may influence use

From: How can we improve guideline use? A conceptual framework of implementability

Study Design Guideline features encouraging use
Brouwers
2009
Canada [48]
Survey of 756 physicians of various specialties between 1999 and 2005 on intended use of 84 cancer guidelines yielding 4,091 surveys Strong supporting evidence, flexibility of recommendations to local context
Wakkee
2008
Netherlands [49]
Questionnaire of 261 dermatologists on characteristics of specific guideline Concise recommendations
Nuckols
2008
United States [39]
Modified Delphi panel of 11 physicians of various specialties Strong supporting evidence, flexibility of recommendations to patient needs and preferences
Francke
2008
Netherlands [7]
Meta-review of 12 systematic reviews on guideline implementation:  
  1. 41 cross sectional pre-/post-test studies or controlled trials Easily accessible, strong supporting evidence, explicit resource implications, flexibility of recommendations to local
  2. 76 survey and qualitative studies  
  3. 91 randomized, cross-over, balanced incomplete block design, controlled before/after, interrupted times series studies context, concise recommendations
  4. 61 mixed methods studies with focus on randomized or controlled trials  
  5. 23 studies of various quantitative designs  
  6. 235 randomized or controlled trials, controlled before/after or interrupted time series designs  
  7. 40 randomized or controlled trials or before/after studies  
  8. 15 randomized or controlled trials, pre-/post-test studies and one systematic review  
  9. 59 studies of various quantitative or qualitative or mixed design  
  10. 6 randomized controlled trials, time series or before/after studies and 8 studies of mixed design  
  11. 18 ranodmized or controlled trials, before/after or interrupted time series studies  
  12. 20 randomized or controlled trials, case series or case reports  
Cochrane
2007
United States [30]
Systematic review of 256 studies of guideline implementation (178 surveys, 16 focus group studies, 18 interview studies, 44 mixed methods studies) Easily accessible, strong supporting evidence, flexibility of recommendations to local context, concise recommendations
Carlsen
2007
Norway [50]
Qualitative analysis of six focus groups involving 27 general practitioners Trustworthy, suit patients, recommended action is feasible
Carlsen
2007
Norway [42]
Systematic review of 12 qualitative studies (7 focus group studies, 5 interview studies) evaluating general practitioner attitudes about guidelines Authorship familiarity, flexibility of recommendations to patient needs and preferences, short and concise, include patient leaflets
Jones
2007
Canada [51]
Qualitative analysis 28 interviews with physicians and nurses in four intensive care units Easily accessible, accompanying tools such as checklists, strong supporting evidence, concise recommendations
Thomason
2007
United States [52]
Survey and focus groups with 60 physicians and nurses who attended a national conferences Strong supporting evidence, concise recommendations
Sinuff
2007
Canada [53]
Qualitative analysis of interviews with 30 physicians and nurses at one hospital Easily accessible, accompanying tools such as algorithms or pocket cards, concise recommendations
McKinlay
2004
New Zealand [54]
Qualitative analysis of interviews with 13 general practitioners from five sites Authorship familiarity, variety of print and electronic formats
Shiffman
2003
United States [55]
Modified Delphi process involving representatives from 22 organizations active in guideline development Explicit resource implications, suggestions for auxiliary documents for providers or patients, evaluative data collection tools
Price
2001
United States [56]
Discourse analysis of laboratory study using clinical scenarios and guidelines of different formats involving three general practitioners and three endocrinologists Algorithmic guidelines were useful for clinical problem solving, textual guidelines were useful for learning
Vinker
2000
Israel [57]
Questionnaire of 293 general practitioners and family physicians participating in educational programs over two months Strong supporting evidence, flexibility of recommendations to patient needs and preferences, concise recommendations
Harris
2000
United States [42]
Questionnaire and focus groups with an undisclosed sample drawn from 304 general practitioners based at 16 sites Accompanying tools such as checklists and standard orders, summaries such as algorithms or diagrams, navigational support such as color-coded tabs, evaluative data collection tools, accessible by computer, information guides for patients
Shekelle
2000
United States [31]
Randomized controlled trial of questionnaire on intent to use guidelines among 545 general internists, neurologists and physical medicine specialists who received usual guideline or guideline modified with clinical vignettes Clinical vignettes describing application of guidelines according to patient needs and preferences
Cabana
1999
United States [58]
Systematic review of 76 journal articles on barriers to guideline adherence among physicians Strong supporting evidence, authorship familiarity, easily accessible, concise recommendations, flexibility of recommendations to patient needs and preferences
Grol
1998
Netherlands [37]
Observational study involving 12,880 decisions made by 61 general practitioners based on 12 guidelines with various attributes rated by participants Strong supporting evidence, concise recommendations, explicit resource implications