Clinical practice guidelines can help health professionals, patients and policymakers to make evidence-based decisions about health care but they are developed inconsistently and may not be optimally presented to assist different decision-makers.
Healthcare decision makers face challenges in understanding guidelines, including the quality of the evidence upon which recommendations are made, which often is not clear. Guidelines are also typically developed as a one-size-fits-all package.
By developing and evaluating targeted communication strategies, DECIDE aims to increase the use of evidence-based interventions in a sustainable way and to reduce the use of interventions where benefits are uncertain. GRADE is a systematic approach towards assessing and communicating the quality of evidence and the strength of recommendations. It has been developed to address the weaknesses of other grading systems and is now widely used internationally.
The DECIDE consortium will further develop this approach to ensure effective communication of evidence-based recommendations targeted at key healthcare stakeholders: healthcare professionals; policymakers and managers; patients and the general public. We will collect stakeholder input from advisory groups, consultations and user testing. This will be done across a wide range of health systems in Europe. The targeted communication strategies that are developed will be evaluated, refined and used and evaluated with real guidelines developed by the DECIDE partners and other guideline developers.
Discussions with hundreds of key stakeholders have led to some clear ideas about improved guideline presentation formats. Chief among these is the idea of presenting information in layers and tailored to the needs of the person targeted by the guideline. The desire among health professionals and patients for guidelines to support shared decisions is strong. An interactive Summary of Findings table, a tool that allows users to tailor evidence presentations to their own needs has been developed and is now being tested; a beta version is available at https://s3.amazonaws.com/prototype_isof/html
Additionally, a tool that guideline producers can use to support the entire guideline production process, including using presentation strategies coming out of DECIDE, called the Guideline Development Tool (GDT) has also been developed (http://www.guidelinedevelopment.org). The GDT will be further developed as part of DECIDE. Presentation strategies are being tested in Scottish dental guidelines, Dutch kidney donation guidelines, WHO lay health worker guidelines and we are working with the European Monitoring Centre for Drugs and Drug Addiction, Lisbon, to improve the way they present the information in their Best Practice Portal. DECIDE has also completed a substantial review of guideline grading systems for medical tests (http://www.implementationscience.com/content/8/1/78). Finally, a major international conference will be held in Edinburgh, Scotland, in June 2014 to showcase and discuss DECIDE’s outputs with an international guideline audience.
DECIDE will build on the work of the GRADE Working Group by developing and evaluating ways of effectively communicating and supporting the uptake of evidence-based recommendations (and the basis for such recommendations). This work will advance the state-of-the-art by taking the successful GRADE system and providing new research data on the most effective ways of using GRADE to develop and disseminate research evidence to key clinical practice stakeholders across different countries, health systems and settings in Europe. It will provide new information on how to tailor global research evidence to local needs.