Abstract
Background: Features of clinical practice guideline (CPG) recommendations may affect understanding and consequently successful uptake and implementation. We aimed to develop a recommendation format to improve understandability among healthcare professionals involved in pediatric cancer care.Methods: We conducted a multi-center qualitative study of health care professionals at participating pediatric oncology sites. We developed an initial format based on the current literature and used the “think-aloud” technique in multiple rounds of one-on-one cognitive interviews to iteratively improve it. Interviews were conducted until the format was well understood and no new, substantive suggestions for revision were raised. We took a directed (deductive) approach to content analysis of the interview notes to identify concerns related to the understandability of the recommendation. Results: Five investigators interviewed 33 healthcare professionals from multiple disciplines in seven rounds. We identified important factors influencing how to communicate recommendations. Regarding the strength of the recommendation, participants found understanding weak recommendations more challenging than strong. Understanding was improved by using the word ‘conditional’ instead of ‘weak’. Participants believed the inclusion of a rationale section to be very helpful. More information was desirable when a recommendation entailed a practice change. Although participants wanted additional information, they were concerned that there could be too much information. They, therefore, suggested that key words and the studies included in the evidence synthesis be hyperlinked to explanatory data. In the final format, the recommendation strength is clearly indicated in the title, highlighted, and defined within a text box. The rationale for the recommendation is in a column on the left, with supporting evidence on the right. In a bulleted list, the rationale section describes the benefits and harms and additional factors, such as implementation, that were balanced by the CPG developers. Each bullet under the supporting evidence section indicates the level of evidence with an explanation and the supporting studies with hyperlinks when applicable. Conclusions: A well-understood recommendation format to present strong and conditional recommendations was created through an iterative interview process. The format is straightforward, making it easy for organizations and CPG developers to use it to communicate recommendations clearly to intended users.
Implementation of the clinical practice guideline for individuals with amputations in Colombia: a qualitative study on perceived barriers and facilitators
