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: | Â |
| Â | 1. 41 cross sectional pre-/post-test studies or controlled trials | Easily accessible, strong supporting evidence, explicit resource implications, flexibility of recommendations to local |
| Â | 2. 76 survey and qualitative studies | Â |
| Â | 3. 91 randomized, cross-over, balanced incomplete block design, controlled before/after, interrupted times series studies | context, concise recommendations |
| Â | 4. 61 mixed methods studies with focus on randomized or controlled trials | Â |
| Â | 5. 23 studies of various quantitative designs | Â |
| Â | 6. 235 randomized or controlled trials, controlled before/after or interrupted time series designs | Â |
| Â | 7. 40 randomized or controlled trials or before/after studies | Â |
| Â | 8. 15 randomized or controlled trials, pre-/post-test studies and one systematic review | Â |
| Â | 9. 59 studies of various quantitative or qualitative or mixed design | Â |
| Â | 10. 6 randomized controlled trials, time series or before/after studies and 8 studies of mixed design | Â |
| Â | 11. 18 ranodmized or controlled trials, before/after or interrupted time series studies | Â |
| Â | 12. 20 randomized or controlled trials, case series or case reports | Â |
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 |